- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,709.80 / $15,511.30 / $27,138.90
| Facility | | $11,709.80 | $15,511.30 | $27,138.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,575.72 / $17,466.02 / $20,682.80
| Facility | | $12,575.72 | $17,466.02 | $20,682.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,939.30 / $14,188.65 / $27,709.21
| Facility | | $5,939.30 | $14,188.65 | $27,709.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,743.55 / $15,754.07 / $24,230.25
| Facility | | $10,743.55 | $15,754.07 | $24,230.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $15,985.11 / $24,415.28
| Facility | | $3,496.00 | $15,985.11 | $24,415.28 |