- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,880.90 / $15,889.30 / $20,884.00
| Facility | | $10,880.90 | $15,889.30 | $20,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,062.26 / $9,062.26 / $13,106.03
| Facility | | $9,062.26 | $9,062.26 | $13,106.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,597.64 / $15,244.49 / $25,784.00
| Facility | | $5,597.64 | $15,244.49 | $25,784.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,053.47 / $15,959.91 / $26,713.29
| Facility | | $11,053.47 | $15,959.91 | $26,713.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,686.65 / $17,811.47 / $26,006.20
| Facility | | $13,686.65 | $17,811.47 | $26,006.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,686.65 / $16,558.14 / $26,006.20
| Facility | | $13,686.65 | $16,558.14 | $26,006.20 |