- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,236.10 / $16,208.40 / $28,358.60
| Facility | | $12,236.10 | $16,208.40 | $28,358.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,359.95 / $13,527.41 / $19,527.24
| Facility | | $8,359.95 | $13,527.41 | $19,527.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,939.30 / $14,078.04 / $28,780.28
| Facility | | $5,939.30 | $14,078.04 | $28,780.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,226.40 / $16,462.12 / $25,319.25
| Facility | | $11,226.40 | $16,462.12 | $25,319.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $16,703.54 / $25,512.60
| Facility | | $3,496.00 | $16,703.54 | $25,512.60 |