- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,958.10 / $13,081.50 / $17,193.59
| Facility | | $8,958.10 | $13,081.50 | $17,193.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,879.98 / $10,566.65 / $17,872.07
| Facility | | $3,879.98 | $10,566.65 | $17,872.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,100.20 / $13,139.63 / $21,992.77
| Facility | | $9,100.20 | $13,139.63 | $21,992.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,268.07 / $14,664.00 / $21,410.63
| Facility | | $11,268.07 | $14,664.00 | $21,410.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,268.07 / $13,632.14 / $21,410.63
| Facility | | $11,268.07 | $13,632.14 | $21,410.63 |