- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,372.29 / $12,226.00 / $16,069.20
| Facility | | $8,372.29 | $12,226.00 | $16,069.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,287.13 / $14,398.85 / $24,353.72
| Facility | | $5,287.13 | $14,398.85 | $24,353.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,505.10 / $12,280.36 / $20,554.55
| Facility | | $8,505.10 | $12,280.36 | $20,554.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,531.20 / $13,705.05 / $20,010.48
| Facility | | $10,531.20 | $13,705.05 | $20,010.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,531.20 / $12,740.67 / $20,010.48
| Facility | | $10,531.20 | $12,740.67 | $20,010.48 |