- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,392.80 / $20,868.80 / $29,547.90
| Facility | | $11,392.80 | $20,868.80 | $29,547.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,942.90 / $20,880.81 / $32,929.53
| Facility | | $12,942.90 | $20,880.81 | $32,929.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,845.02 / $18,772.56 / $33,399.37
| Facility | | $11,845.02 | $18,772.56 | $33,399.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,117.00 / $18,300.56 / $39,494.81
| Facility | | $7,117.00 | $18,300.56 | $39,494.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $17,326.03 / $35,097.15
| Facility | | $3,308.00 | $17,326.03 | $35,097.15 |