- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,956.20 / $18,237.40 / $25,822.10
| Facility | | $9,956.20 | $18,237.40 | $25,822.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,164.09 / $16,164.09 / $16,164.09
| Facility | | $16,164.09 | $16,164.09 | $16,164.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,093.00 / $16,187.49 / $25,460.32
| Facility | | $10,093.00 | $16,187.49 | $25,460.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,351.44 / $16,405.46 / $29,187.92
| Facility | | $10,351.44 | $16,405.46 | $29,187.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,587.28 / $15,605.63 / $34,514.78
| Facility | | $6,587.28 | $15,605.63 | $34,514.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $15,141.33 / $30,671.63
| Facility | | $3,308.00 | $15,141.33 | $30,671.63 |