- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,020.70 / $18,812.00 / $30,577.40
| Facility | | $11,020.70 | $18,812.00 | $30,577.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,687.00 / $14,725.06 / $19,822.14
| Facility | | $9,687.00 | $14,725.06 | $19,822.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,415.02 / $14,947.06 / $23,580.43
| Facility | | $9,415.02 | $14,947.06 | $23,580.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,849.23 / $12,585.82 / $23,808.78
| Facility | | $6,849.23 | $12,585.82 | $23,808.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,289.00 / $15,829.80 / $21,473.76
| Facility | | $6,289.00 | $15,829.80 | $21,473.76 |