- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,639.90 / $18,101.90 / $27,595.30
| Facility | | $10,639.90 | $18,101.90 | $27,595.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,152.32 / $17,925.08 / $28,167.54
| Facility | | $11,152.32 | $17,925.08 | $28,167.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,062.26 / $17,532.00 / $31,192.22
| Facility | | $11,062.26 | $17,532.00 | $31,192.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,414.00 / $16,541.43 / $36,884.86
| Facility | | $6,414.00 | $16,541.43 | $36,884.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $15,653.10 / $32,777.81
| Facility | | $3,308.00 | $15,653.10 | $32,777.81 |