- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,656.70 / $15,562.00 / $20,453.80
| Facility | | $10,656.70 | $15,562.00 | $20,453.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,455.97 / $12,135.30 / $20,525.23
| Facility | | $4,455.97 | $12,135.30 | $20,525.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,825.80 / $15,631.18 / $28,010.10
| Facility | | $10,825.80 | $15,631.18 | $28,010.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,404.74 / $17,444.59 / $25,470.54
| Facility | | $13,404.74 | $17,444.59 | $25,470.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,404.74 / $16,217.08 / $25,470.54
| Facility | | $13,404.74 | $16,217.08 | $25,470.54 |