- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,897.40 / $20,308.40 / $33,009.80
| Facility | | $11,897.40 | $20,308.40 | $33,009.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,622.00 / $19,264.91 / $25,055.41
| Facility | | $11,622.00 | $19,264.91 | $25,055.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,201.96 / $16,136.06 / $25,456.20
| Facility | | $10,201.96 | $16,136.06 | $25,456.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,663.53 / $14,220.39 / $25,702.72
| Facility | | $7,663.53 | $14,220.39 | $25,702.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,289.00 / $17,089.03 / $23,181.95
| Facility | | $6,289.00 | $17,089.03 | $23,181.95 |