- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,270.29 / $11,411.40 / $11,411.40
| Facility | | $10,270.29 | $11,411.40 | $11,411.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,920.30 / $9,476.50 / $14,141.00
| Facility | | $4,920.30 | $9,476.50 | $14,141.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,286.25 / $5,575.22 / $12,653.55
| Facility | | $3,286.25 | $5,575.22 | $12,653.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,981.00 / $12,564.35 / $19,745.75
| Facility | | $7,981.00 | $12,564.35 | $19,745.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $17,048.39 / $22,012.32
| Facility | | $6,965.00 | $17,048.39 | $22,012.32 |