- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,431.10 / $16,215.20 / $22,731.40
| Facility | | $10,431.10 | $16,215.20 | $22,731.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,476.18 / $20,476.18 / $20,902.68
| Facility | | $20,476.18 | $20,476.18 | $20,902.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,529.75 / $15,270.07 / $23,134.49
| Facility | | $9,529.75 | $15,270.07 | $23,134.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,150.00 / $13,743.75 / $23,528.56
| Facility | | $7,150.00 | $13,743.75 | $23,528.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,150.00 / $13,573.19 / $20,886.56
| Facility | | $7,150.00 | $13,573.19 | $20,886.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,675.38 / $17,948.89 / $25,266.69
| Facility | | $7,675.38 | $17,948.89 | $25,266.69 |