- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $12,882.50 / $20,892.96
| Facility | | $10,715.19 | $12,882.50 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $17,378.01 / $27,542.29
| Facility | | $13,182.57 | $17,378.01 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $15,488.17 / $23,442.29
| Facility | | $11,220.18 | $15,488.17 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $12,589.25 / $19,952.62
| Facility | | $4,265.80 | $12,589.25 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $12,882.50 / $19,952.62
| Facility | | $4,265.80 | $12,882.50 | $19,952.62 |