- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,210.00 / $17,428.09 / $28,327.90
| Facility | | $10,210.00 | $17,428.09 | $28,327.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,996.09 / $14,996.09 / $14,996.09
| Facility | | $14,996.09 | $14,996.09 | $14,996.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,755.01 / $13,847.47 / $21,845.73
| Facility | | $8,755.01 | $13,847.47 | $21,845.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,141.98 / $12,839.35 / $23,896.53
| Facility | | $7,141.98 | $12,839.35 | $23,896.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,289.00 / $14,665.28 / $19,894.03
| Facility | | $6,289.00 | $14,665.28 | $19,894.03 |