- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,997.08 / $15,194.70 / $25,226.80
| Facility | | $10,997.08 | $15,194.70 | $25,226.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,167.47 / $25,167.47 / $25,167.47
| Facility | | $25,167.47 | $25,167.47 | $25,167.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,122.17 / $13,665.56 / $23,149.74
| Facility | | $9,122.17 | $13,665.56 | $23,149.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,187.23 / $16,929.89 / $25,625.00
| Facility | | $13,187.23 | $16,929.89 | $25,625.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,787.00 / $16,368.43 / $26,082.66
| Facility | | $8,787.00 | $16,368.43 | $26,082.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,141.88 / $16,368.43 / $21,833.25
| Facility | | $8,141.88 | $16,368.43 | $21,833.25 |