- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,195.90 / $14,662.10 / $14,662.10
| Facility | | $13,195.90 | $14,662.10 | $14,662.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,895.48 / $14,141.00 / $21,419.10
| Facility | | $10,895.48 | $14,141.00 | $21,419.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,093.63 / $12,569.34 / $27,383.56
| Facility | | $8,093.63 | $12,569.34 | $27,383.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,120.01 / $16,552.29 / $25,370.59
| Facility | | $12,120.01 | $16,552.29 | $25,370.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $21,904.85 / $28,282.83
| Facility | | $6,965.00 | $21,904.85 | $28,282.83 |