- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,072.50 / $17,760.09 / $27,964.60
| Facility | | $13,072.50 | $17,760.09 | $27,964.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,641.90 / $16,232.07 / $23,690.62
| Facility | | $10,641.90 | $16,232.07 | $23,690.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,341.41 / $15,201.19 / $28,496.00
| Facility | | $11,341.41 | $15,201.19 | $28,496.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.00 / $166.97 / $266.11
| Facility | | $120.00 | $166.97 | $266.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,561.04 / $17,383.98 / $28,609.98
| Facility | | $12,561.04 | $17,383.98 | $28,609.98 |