- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,207.60 / $13,564.00 / $13,564.00
| Facility | | $12,207.60 | $13,564.00 | $13,564.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,821.05 / $11,035.71 / $18,881.96
| Facility | | $6,821.05 | $11,035.71 | $18,881.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,977.72 / $8,589.20 / $16,100.65
| Facility | | $4,977.72 | $8,589.20 | $16,100.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,212.31 / $15,894.74 / $24,050.27
| Facility | | $11,212.31 | $15,894.74 | $24,050.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $20,264.33 / $26,164.64
| Facility | | $6,965.00 | $20,264.33 | $26,164.64 |