- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,094.20 / $14,740.60 / $19,374.20
| Facility | | $10,094.20 | $14,740.60 | $19,374.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,560.17 / $12,422.71 / $13,887.02
| Facility | | $8,560.17 | $12,422.71 | $13,887.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,762.72 / $12,970.72 / $21,938.22
| Facility | | $4,762.72 | $12,970.72 | $21,938.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,254.36 / $14,806.09 / $24,782.04
| Facility | | $10,254.36 | $14,806.09 | $24,782.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,697.17 / $16,523.79 / $24,126.08
| Facility | | $12,697.17 | $16,523.79 | $24,126.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,697.17 / $15,361.06 / $24,126.08
| Facility | | $12,697.17 | $15,361.06 | $24,126.08 |