- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,364.60 / $15,681.30 / $26,244.90
| Facility | | $11,364.60 | $15,681.30 | $26,244.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,089.46 / $26,089.46 / $26,089.46
| Facility | | $26,089.46 | $26,089.46 | $26,089.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,272.00 / $19,452.79 / $29,960.46
| Facility | | $3,272.00 | $19,452.79 | $29,960.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,631.55 / $17,642.14 / $29,585.76
| Facility | | $11,631.55 | $17,642.14 | $29,585.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $17,990.29 / $31,763.07
| Facility | | $4,062.00 | $17,990.29 | $31,763.07 |