- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,724.90 / $19,645.50 / $27,815.90
| Facility | | $10,724.90 | $19,645.50 | $27,815.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,490.48 / $18,451.54 / $29,534.85
| Facility | | $11,490.48 | $18,451.54 | $29,534.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,150.70 / $17,672.16 / $31,441.60
| Facility | | $11,150.70 | $17,672.16 | $31,441.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,095.90 / $16,568.43 / $37,179.75
| Facility | | $7,095.90 | $16,568.43 | $37,179.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $16,310.43 / $33,039.86
| Facility | | $3,308.00 | $16,310.43 | $33,039.86 |