- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,380.70 / $20,846.70 / $29,516.70
| Facility | | $11,380.70 | $20,846.70 | $29,516.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,439.00 / $18,453.88 / $29,303.67
| Facility | | $11,439.00 | $18,453.88 | $29,303.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,832.48 / $18,752.68 / $33,364.01
| Facility | | $11,832.48 | $18,752.68 | $33,364.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,117.00 / $17,693.14 / $39,453.00
| Facility | | $7,117.00 | $17,693.14 | $39,453.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $17,307.68 / $35,060.00
| Facility | | $3,308.00 | $17,307.68 | $35,060.00 |