- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,181.99 / $15,414.00 / $25,272.80
| Facility | | $7,181.99 | $15,414.00 | $25,272.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,934.00 / $22,636.95 / $33,641.12
| Facility | | $9,934.00 | $22,636.95 | $33,641.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,646.00 / $20,576.57 / $32,899.76
| Facility | | $14,646.00 | $20,576.57 | $32,899.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,543.27 / $21,288.72 / $43,716.53
| Facility | | $10,543.27 | $21,288.72 | $43,716.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,707.27 / $8,707.27 / $8,707.27
| Facility | | $8,707.27 | $8,707.27 | $8,707.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,257.39 / $21,726.48 / $32,907.89
| Facility | | $13,257.39 | $21,726.48 | $32,907.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,870.00 / $16,568.00 / $28,302.83
| Facility | | $4,870.00 | $16,568.00 | $28,302.83 |