- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,071.48 / $14,785.00 / $20,934.00
| Facility | | $8,071.48 | $14,785.00 | $20,934.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,939.86 / $14,412.01 / $22,676.57
| Facility | | $8,939.86 | $14,412.01 | $22,676.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,391.90 / $13,299.89 / $23,662.62
| Facility | | $8,391.90 | $13,299.89 | $23,662.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,340.30 / $12,275.06 / $27,981.09
| Facility | | $5,340.30 | $12,275.06 | $27,981.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $12,275.06 / $24,865.45
| Facility | | $3,308.00 | $12,275.06 | $24,865.45 |