- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,390.04 / $12,252.00 / $16,103.30
| Facility | | $8,390.04 | $12,252.00 | $16,103.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,105.14 / $13,903.22 / $23,515.43
| Facility | | $5,105.14 | $13,903.22 | $23,515.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,523.12 / $12,306.40 / $20,598.13
| Facility | | $8,523.12 | $12,306.40 | $20,598.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,553.53 / $13,734.10 / $20,052.91
| Facility | | $10,553.53 | $13,734.10 | $20,052.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,553.53 / $12,767.68 / $20,052.91
| Facility | | $10,553.53 | $12,767.68 | $20,052.91 |