- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,425.20 / $13,809.60 / $24,161.60
| Facility | | $10,425.20 | $13,809.60 | $24,161.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,120.26 / $11,196.54 / $14,815.00
| Facility | | $7,120.26 | $11,196.54 | $14,815.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,843.91 / $11,791.89 / $23,685.89
| Facility | | $5,843.91 | $11,791.89 | $23,685.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,892.66 / $14,025.79 / $21,572.10
| Facility | | $9,892.66 | $14,025.79 | $21,572.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $14,231.48 / $21,736.83
| Facility | | $3,496.00 | $14,231.48 | $21,736.83 |