- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,522.00 / $15,262.50 / $26,703.60
| Facility | | $11,522.00 | $15,262.50 | $26,703.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,682.96 / $12,287.70 / $18,903.18
| Facility | | $8,682.96 | $12,287.70 | $18,903.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,843.91 / $13,395.21 / $26,159.69
| Facility | | $5,843.91 | $13,395.21 | $26,159.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,571.25 / $15,501.42 / $23,841.68
| Facility | | $10,571.25 | $15,501.42 | $23,841.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $15,728.76 / $24,023.74
| Facility | | $3,496.00 | $15,728.76 | $24,023.74 |