- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,654.80 / $15,438.40 / $27,011.30
| Facility | | $11,654.80 | $15,438.40 | $27,011.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,330.00 / $12,906.49 / $17,110.00
| Facility | | $10,330.00 | $12,906.49 | $17,110.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,939.30 / $13,559.44 / $27,720.08
| Facility | | $5,939.30 | $13,559.44 | $27,720.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,693.07 / $15,680.04 / $24,116.40
| Facility | | $10,693.07 | $15,680.04 | $24,116.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $15,910.00 / $24,300.56
| Facility | | $3,496.00 | $15,910.00 | $24,300.56 |