- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,595.60 / $18,732.40 / $25,920.90
| Facility | | $11,595.60 | $18,732.40 | $25,920.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,781.21 / $14,781.21 / $14,781.21
| Facility | | $14,781.21 | $14,781.21 | $14,781.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,617.65 / $17,013.28 / $25,775.49
| Facility | | $10,617.65 | $17,013.28 | $25,775.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,516.00 / $15,672.12 / $26,125.93
| Facility | | $7,516.00 | $15,672.12 | $26,125.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,516.00 / $15,477.62 / $23,817.12
| Facility | | $7,516.00 | $15,477.62 | $23,817.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,178.45 / $19,997.91 / $27,876.39
| Facility | | $9,178.45 | $19,997.91 | $27,876.39 |