- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,942.60 / $18,678.59 / $30,360.60
| Facility | | $10,942.60 | $18,678.59 | $30,360.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,687.00 / $15,165.57 / $19,536.66
| Facility | | $9,687.00 | $15,165.57 | $19,536.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,383.20 / $14,841.07 / $23,413.23
| Facility | | $9,383.20 | $14,841.07 | $23,413.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,714.09 / $13,757.13 / $25,250.97
| Facility | | $7,714.09 | $13,757.13 | $25,250.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,289.00 / $15,717.56 / $21,321.49
| Facility | | $6,289.00 | $15,717.56 | $21,321.49 |