- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,332.90 / $22,590.90 / $31,986.30
| Facility | | $12,332.90 | $22,590.90 | $31,986.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,696.16 / $20,351.93 / $31,981.12
| Facility | | $12,696.16 | $20,351.93 | $31,981.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,822.48 / $20,321.68 / $36,155.51
| Facility | | $12,822.48 | $20,321.68 | $36,155.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,382.64 / $19,173.49 / $42,753.96
| Facility | | $7,382.64 | $19,173.49 | $42,753.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $19,173.49 / $39,466.10
| Facility | | $3,308.00 | $19,173.49 | $39,466.10 |