- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,078.70 / $18,461.80 / $26,139.90
| Facility | | $10,078.70 | $18,461.80 | $26,139.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,636.28 / $18,674.28 / $30,836.46
| Facility | | $11,636.28 | $18,674.28 | $30,836.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,478.82 / $16,607.34 / $29,547.10
| Facility | | $10,478.82 | $16,607.34 | $29,547.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,668.34 / $15,669.01 / $34,939.50
| Facility | | $6,668.34 | $15,669.01 | $34,939.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $15,327.66 / $31,049.06
| Facility | | $3,308.00 | $15,327.66 | $31,049.06 |