- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,390.15 / $15,368.70 / $21,760.50
| Facility | | $8,390.15 | $15,368.70 | $21,760.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,728.56 / $13,728.56 / $13,728.56
| Facility | | $13,728.56 | $13,728.56 | $13,728.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,787.97 / $18,604.91 / $31,429.54
| Facility | | $10,787.97 | $18,604.91 | $31,429.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,723.21 / $17,683.00 / $27,412.00
| Facility | | $8,723.21 | $17,683.00 | $27,412.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,551.14 / $13,131.02 / $29,085.81
| Facility | | $5,551.14 | $13,131.02 | $29,085.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $12,759.69 / $25,847.17
| Facility | | $3,308.00 | $12,759.69 | $25,847.17 |