- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,947.80 / $18,949.30 / $27,415.00
| Facility | | $13,947.80 | $18,949.30 | $27,415.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,351.36 / $17,294.56 / $25,270.00
| Facility | | $11,351.36 | $17,294.56 | $25,270.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,167.68 / $16,816.00 / $30,404.00
| Facility | | $12,167.68 | $16,816.00 | $30,404.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.00 / $178.15 / $283.93
| Facility | | $125.00 | $178.15 | $283.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,716.47 / $18,523.64 / $29,403.71
| Facility | | $12,716.47 | $18,523.64 | $29,403.71 |