- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,012.00 / $19,947.70 / $30,481.00
| Facility | | $3,012.00 | $19,947.70 | $30,481.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,948.80 / $18,134.40 / $26,625.90
| Facility | | $11,948.80 | $18,134.40 | $26,625.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,808.80 / $17,966.57 / $31,765.96
| Facility | | $12,808.80 | $17,966.57 | $31,765.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.86 / $184.99 / $322.08
| Facility | | $127.86 | $184.99 | $322.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,708.36 / $20,647.07 / $31,052.00
| Facility | | $14,708.36 | $20,647.07 | $31,052.00 |