- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,292.91 / $17,206.80 / $23,081.40
| Facility | | $8,292.91 | $17,206.80 | $23,081.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,601.09 / $18,916.58 / $20,918.28
| Facility | | $16,601.09 | $18,916.58 | $20,918.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $17,510.33 / $20,820.59
| Facility | | $3,897.00 | $17,510.33 | $20,820.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,625.75 / $17,767.84 / $27,966.05
| Facility | | $14,625.75 | $17,767.84 | $27,966.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $21,951.71 / $27,723.46
| Facility | | $1,350.00 | $21,951.71 | $27,723.46 |