- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,725.30 / $14,139.20 / $14,139.20
| Facility | | $12,725.30 | $14,139.20 | $14,139.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,777.53 / $4,777.53 / $9,603.59
| Facility | | $4,777.53 | $4,777.53 | $9,603.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,462.33 / $8,414.79 / $15,776.55
| Facility | | $5,462.33 | $8,414.79 | $15,776.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,824.23 / $15,567.74 / $24,465.79
| Facility | | $8,824.23 | $15,567.74 | $24,465.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $21,123.65 / $27,274.17
| Facility | | $6,965.00 | $21,123.65 | $27,274.17 |