- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,736.20 / $11,929.10 / $11,929.10
| Facility | | $10,736.20 | $11,929.10 | $11,929.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,476.47 / $7,559.50 / $10,840.73
| Facility | | $5,476.47 | $7,559.50 | $10,840.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,240.02 / $13,032.32 / $20,749.93
| Facility | | $8,240.02 | $13,032.32 | $20,749.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,860.84 / $13,978.87 / $21,151.38
| Facility | | $9,860.84 | $13,978.87 | $21,151.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $17,821.78 / $23,010.90
| Facility | | $6,965.00 | $17,821.78 | $23,010.90 |