- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,482.30 / $21,306.80 / $34,632.50
| Facility | | $12,482.30 | $21,306.80 | $34,632.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,258.00 / $11,258.00 / $14,757.80
| Facility | | $11,258.00 | $11,258.00 | $14,757.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,663.61 / $16,929.29 / $26,707.59
| Facility | | $10,663.61 | $16,929.29 | $26,707.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,894.29 / $12,912.08 / $26,935.56
| Facility | | $5,894.29 | $12,912.08 | $26,935.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,478.19 / $19,265.24 / $25,646.44
| Facility | | $12,478.19 | $19,265.24 | $25,646.44 |