- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,860.79 / $12,922.00 / $20,976.50
| Facility | | $8,860.79 | $12,922.00 | $20,976.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,122.46 / $21,122.46 / $21,122.46
| Facility | | $21,122.46 | $21,122.46 | $21,122.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,329.35 / $21,792.97 / $27,939.70
| Facility | | $15,329.35 | $21,792.97 | $27,939.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,404.66 / $20,116.43 / $25,443.65
| Facility | | $10,404.66 | $20,116.43 | $25,443.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,244.77 / $13,896.70 / $22,221.40
| Facility | | $9,244.77 | $13,896.70 | $22,221.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,811.65 / $18,488.06 / $28,088.74
| Facility | | $10,811.65 | $18,488.06 | $28,088.74 |