- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,235.40 / $18,276.20 / $25,115.70
| Facility | | $11,235.40 | $18,276.20 | $25,115.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,987.52 / $13,987.52 / $13,987.52
| Facility | | $13,987.52 | $13,987.52 | $13,987.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,829.37 / $17,352.53 / $26,289.46
| Facility | | $10,829.37 | $17,352.53 | $26,289.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,516.00 / $15,185.29 / $25,996.40
| Facility | | $7,516.00 | $15,185.29 | $25,996.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,516.00 / $14,996.84 / $23,077.28
| Facility | | $7,516.00 | $14,996.84 | $23,077.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,480.43 / $20,396.68 / $28,652.70
| Facility | | $8,480.43 | $20,396.68 | $28,652.70 |