- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,343.30 / $12,603.60 / $12,603.60
| Facility | | $11,343.30 | $12,603.60 | $12,603.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,513.81 / $10,513.81 / $12,743.73
| Facility | | $10,513.81 | $10,513.81 | $12,743.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,413.21 / $14,202.70 / $28,990.65
| Facility | | $8,413.21 | $14,202.70 | $28,990.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,418.42 / $14,769.32 / $23,613.00
| Facility | | $10,418.42 | $14,769.32 | $23,613.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $18,829.52 / $24,312.07
| Facility | | $6,965.00 | $18,829.52 | $24,312.07 |