- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,490.80 / $19,614.40 / $31,881.60
| Facility | | $11,490.80 | $19,614.40 | $31,881.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,231.00 / $11,660.04 / $19,595.25
| Facility | | $11,231.00 | $11,660.04 | $19,595.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,853.32 / $15,584.62 / $24,586.24
| Facility | | $9,853.32 | $15,584.62 | $24,586.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,803.47 / $12,651.75 / $24,824.34
| Facility | | $6,803.47 | $12,651.75 | $24,824.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,289.00 / $16,505.00 / $22,389.71
| Facility | | $6,289.00 | $16,505.00 | $22,389.71 |