- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,683.60 / $14,151.90 / $24,760.40
| Facility | | $10,683.60 | $14,151.90 | $24,760.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,000.00 / $13,128.54 / $18,467.63
| Facility | | $6,000.00 | $13,128.54 | $18,467.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,843.91 / $12,137.02 / $23,482.01
| Facility | | $5,843.91 | $12,137.02 | $23,482.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,856.81 / $14,373.37 / $22,106.70
| Facility | | $9,856.81 | $14,373.37 | $22,106.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $14,584.17 / $22,275.51
| Facility | | $3,496.00 | $14,584.17 | $22,275.51 |