- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,882.10 / $14,414.90 / $25,220.60
| Facility | | $10,882.10 | $14,414.90 | $25,220.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,032.65 / $11,813.28 / $19,345.90
| Facility | | $11,032.65 | $11,813.28 | $19,345.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,843.91 / $12,594.48 / $25,569.78
| Facility | | $5,843.91 | $12,594.48 | $25,569.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,326.23 / $14,640.50 / $22,517.55
| Facility | | $10,326.23 | $14,640.50 | $22,517.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $14,855.21 / $22,689.50
| Facility | | $3,496.00 | $14,855.21 | $22,689.50 |