- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,276.00 / $20,560.40 / $23,256.60
| Facility | | $13,276.00 | $20,560.40 | $23,256.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,880.11 / $20,993.26 / $28,873.52
| Facility | | $13,880.11 | $20,993.26 | $28,873.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,259.38 / $19,088.33 / $28,883.97
| Facility | | $12,259.38 | $19,088.33 | $28,883.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,928.00 / $21,318.00 / $26,945.00
| Facility | | $13,928.00 | $21,318.00 | $26,945.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $19,174.91 / $31,535.13
| Facility | | $5,274.00 | $19,174.91 | $31,535.13 |