- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,092.43 / $16,757.70 / $27,821.70
| Facility | | $12,092.43 | $16,757.70 | $27,821.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,308.00 / $14,826.64 / $20,586.50
| Facility | | $9,308.00 | $14,826.64 | $20,586.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,128.56 / $15,173.18 / $25,703.69
| Facility | | $10,128.56 | $15,173.18 | $25,703.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,444.58 / $17,873.98 / $25,700.61
| Facility | | $14,444.58 | $17,873.98 | $25,700.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,787.00 / $17,562.22 / $28,765.61
| Facility | | $8,787.00 | $17,562.22 | $28,765.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,636.00 / $16,710.25 / $23,771.64
| Facility | | $8,636.00 | $16,710.25 | $23,771.64 |