- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,531.11 / $14,754.00 / $16,696.50
| Facility | | $9,531.11 | $14,754.00 | $16,696.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,326.96 / $14,106.77 / $19,052.25
| Facility | | $9,326.96 | $14,106.77 | $19,052.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,801.29 / $13,400.00 / $18,507.82
| Facility | | $8,801.29 | $13,400.00 | $18,507.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,158.00 / $15,214.00 / $19,893.00
| Facility | | $10,158.00 | $15,214.00 | $19,893.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,274.00 / $17,051.59 / $22,694.29
| Facility | | $5,274.00 | $17,051.59 | $22,694.29 |