- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,962.30 / $14,521.00 / $25,406.30
| Facility | | $10,962.30 | $14,521.00 | $25,406.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,897.52 / $7,897.52 / $20,814.52
| Facility | | $7,897.52 | $7,897.52 | $20,814.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,843.91 / $12,774.44 / $25,379.49
| Facility | | $5,843.91 | $12,774.44 | $25,379.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,402.28 / $14,748.32 / $22,683.38
| Facility | | $10,402.28 | $14,748.32 | $22,683.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $14,964.61 / $22,856.59
| Facility | | $3,496.00 | $14,964.61 | $22,856.59 |