- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,588.20 / $19,067.90 / $28,200.00
| Facility | | $13,588.20 | $19,067.90 | $28,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,060.10 / $16,850.81 / $24,621.62
| Facility | | $11,060.10 | $16,850.81 | $24,621.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,853.92 / $16,365.05 / $29,620.00
| Facility | | $11,853.92 | $16,365.05 | $29,620.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.09 / $173.56 / $276.61
| Facility | | $124.09 | $173.56 | $276.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,056.50 / $18,069.68 / $29,738.48
| Facility | | $13,056.50 | $18,069.68 | $29,738.48 |