- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,750.91 / $16,644.40 / $27,054.20
| Facility | | $9,750.91 | $16,644.40 | $27,054.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,875.00 / $16,469.47 / $19,869.25
| Facility | | $15,875.00 | $16,469.47 | $19,869.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,361.34 / $13,224.82 / $20,863.43
| Facility | | $8,361.34 | $13,224.82 | $20,863.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,986.63 / $11,515.83 / $21,041.51
| Facility | | $5,986.63 | $11,515.83 | $21,041.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,505.00 / $14,005.85 / $18,999.49
| Facility | | $6,505.00 | $14,005.85 | $18,999.49 |