- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,653.40 / $14,953.20 / $24,825.90
| Facility | | $11,653.40 | $14,953.20 | $24,825.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,249.45 / $14,159.44 / $23,931.55
| Facility | | $9,249.45 | $14,159.44 | $23,931.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,680.30 / $15,230.16 / $22,933.24
| Facility | | $11,680.30 | $15,230.16 | $22,933.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,012.50 / $16,012.18 / $41,359.89
| Facility | | $8,012.50 | $16,012.18 | $41,359.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,012.50 / $15,287.85 / $21,486.32
| Facility | | $8,012.50 | $15,287.85 | $21,486.32 |