- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,188.90 / $15,201.10 / $23,935.10
| Facility | | $11,188.90 | $15,201.10 | $23,935.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,110.95 / $14,087.75 / $20,498.43
| Facility | | $9,110.95 | $14,087.75 | $20,498.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,760.87 / $13,475.48 / $24,390.00
| Facility | | $9,760.87 | $13,475.48 | $24,390.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.75 / $142.91 / $227.77
| Facility | | $103.75 | $142.91 | $227.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,751.11 / $14,879.12 / $24,487.56
| Facility | | $10,751.11 | $14,879.12 | $24,487.56 |