- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,947.00 / $14,364.00 / $27,551.10
| Facility | | $1,947.00 | $14,364.00 | $27,551.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,718.00 / $16,934.66 / $20,939.11
| Facility | | $9,718.00 | $16,934.66 | $20,939.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,789.40 / $15,612.14 / $25,022.53
| Facility | | $9,789.40 | $15,612.14 | $25,022.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,036.90 / $14,406.83 / $26,501.37
| Facility | | $8,036.90 | $14,406.83 | $26,501.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,021.00 / $14,912.00 / $23,744.82
| Facility | | $8,021.00 | $14,912.00 | $23,744.82 |