- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,498.10 / $21,061.80 / $29,821.20
| Facility | | $11,498.10 | $21,061.80 | $29,821.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,574.80 / $18,718.88 / $29,247.87
| Facility | | $11,574.80 | $18,718.88 | $29,247.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,954.58 / $18,946.20 / $33,708.29
| Facility | | $11,954.58 | $18,946.20 | $33,708.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,117.00 / $18,614.70 / $39,860.12
| Facility | | $7,117.00 | $18,614.70 | $39,860.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $17,486.29 / $35,421.78
| Facility | | $3,308.00 | $17,486.29 | $35,421.78 |