- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,540.90 / $12,823.30 / $12,823.30
| Facility | | $11,540.90 | $12,823.30 | $12,823.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,353.48 / $14,141.00 / $20,059.90
| Facility | | $5,353.48 | $14,141.00 | $20,059.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,704.96 / $9,487.91 / $19,705.27
| Facility | | $5,704.96 | $9,487.91 | $19,705.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,593.00 / $14,118.82 / $22,188.71
| Facility | | $9,593.00 | $14,118.82 | $22,188.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $19,157.63 / $24,735.71
| Facility | | $6,965.00 | $19,157.63 | $24,735.71 |