- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,808.40 / $19,075.90 / $30,438.60
| Facility | | $13,808.40 | $19,075.90 | $30,438.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,022.10 / $17,079.46 / $24,952.90
| Facility | | $11,022.10 | $17,079.46 | $24,952.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,046.02 / $16,630.25 / $30,100.00
| Facility | | $12,046.02 | $16,630.25 | $30,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.00 / $176.37 / $281.08
| Facility | | $125.00 | $176.37 | $281.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,268.08 / $18,362.50 / $30,220.40
| Facility | | $13,268.08 | $18,362.50 | $30,220.40 |