- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,119.20 / $17,632.20 / $30,719.40
| Facility | | $10,119.20 | $17,632.20 | $30,719.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,687.00 / $12,588.66 / $17,550.37
| Facility | | $9,687.00 | $12,588.66 | $17,550.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,162.41 / $12,910.18 / $20,367.05
| Facility | | $8,162.41 | $12,910.18 | $20,367.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,651.15 / $10,935.45 / $20,540.90
| Facility | | $5,651.15 | $10,935.45 | $20,540.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,289.00 / $13,672.62 / $18,568.50
| Facility | | $6,289.00 | $13,672.62 | $18,568.50 |