- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,530.80 / $13,923.10 / $13,923.10
| Facility | | $12,530.80 | $13,923.10 | $13,923.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,737.35 / $14,141.00 / $22,338.71
| Facility | | $12,737.35 | $14,141.00 | $22,338.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,558.48 / $12,096.09 / $21,458.91
| Facility | | $7,558.48 | $12,096.09 | $21,458.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,509.11 / $15,717.99 / $24,091.81
| Facility | | $11,509.11 | $15,717.99 | $24,091.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $20,800.75 / $26,857.25
| Facility | | $6,965.00 | $20,800.75 | $26,857.25 |