- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,141.60 / $17,311.40 / $28,138.20
| Facility | | $10,141.60 | $17,311.40 | $28,138.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,421.08 / $12,216.70 / $19,270.00
| Facility | | $10,421.08 | $12,216.70 | $19,270.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,696.37 / $13,754.74 / $21,699.43
| Facility | | $8,696.37 | $13,754.74 | $21,699.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.42 / $11,623.08 / $21,909.57
| Facility | | $6,303.42 | $11,623.08 | $21,909.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,164.00 / $14,366.06 / $19,937.72
| Facility | | $6,164.00 | $14,366.06 | $19,937.72 |