- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,719.40 / $14,199.40 / $24,843.60
| Facility | | $10,719.40 | $14,199.40 | $24,843.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,346.01 / $11,786.38 / $18,434.43
| Facility | | $8,346.01 | $11,786.38 | $18,434.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,843.91 / $12,264.22 / $24,933.66
| Facility | | $5,843.91 | $12,264.22 | $24,933.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,171.87 / $14,421.65 / $22,180.95
| Facility | | $10,171.87 | $14,421.65 | $22,180.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $14,633.15 / $22,350.33
| Facility | | $3,496.00 | $14,633.15 | $22,350.33 |