- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,557.40 / $13,952.70 / $13,952.70
| Facility | | $12,557.40 | $13,952.70 | $13,952.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,193.99 / $12,193.99 / $24,797.73
| Facility | | $12,193.99 | $12,193.99 | $24,797.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,865.26 / $11,702.88 / $19,147.46
| Facility | | $5,865.26 | $11,702.88 | $19,147.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,533.60 / $15,751.44 / $24,143.08
| Facility | | $11,533.60 | $15,751.44 | $24,143.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $20,845.02 / $26,914.41
| Facility | | $6,965.00 | $20,845.02 | $26,914.41 |