- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,815.62 / $15,047.90 / $24,459.20
| Facility | | $8,815.62 | $15,047.90 | $24,459.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,258.00 / $14,107.39 / $14,316.21
| Facility | | $11,258.00 | $14,107.39 | $14,316.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,559.34 / $11,956.32 / $18,862.25
| Facility | | $7,559.34 | $11,956.32 | $18,862.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,107.78 / $9,664.75 / $19,023.25
| Facility | | $5,107.78 | $9,664.75 | $19,023.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,251.80 / $12,662.44 / $17,196.59
| Facility | | $6,251.80 | $12,662.44 | $17,196.59 |