- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,421.29 / $13,846.00 / $21,377.00
| Facility | | $9,421.29 | $13,846.00 | $21,377.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,444.44 / $20,534.91 / $26,326.82
| Facility | | $14,444.44 | $20,534.91 | $26,326.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,603.34 / $20,500.57 / $25,929.51
| Facility | | $10,603.34 | $20,500.57 | $25,929.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,421.29 / $14,162.00 / $22,645.70
| Facility | | $9,421.29 | $14,162.00 | $22,645.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,018.11 / $18,841.09 / $28,625.10
| Facility | | $11,018.11 | $18,841.09 | $28,625.10 |