- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,764.58 / $12,348.70 / $20,501.70
| Facility | | $8,764.58 | $12,348.70 | $20,501.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,656.75 / $11,470.27 / $19,430.88
| Facility | | $7,656.75 | $11,470.27 | $19,430.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,592.00 / $13,171.29 / $18,938.70
| Facility | | $10,592.00 | $13,171.29 | $18,938.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,616.88 / $13,223.16 / $34,237.99
| Facility | | $6,616.88 | $13,223.16 | $34,237.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,616.88 / $12,493.72 / $17,743.81
| Facility | | $6,616.88 | $12,493.72 | $17,743.81 |