- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,727.70 / $20,018.70 / $32,538.90
| Facility | | $11,727.70 | $20,018.70 | $32,538.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,258.00 / $18,513.81 / $19,538.24
| Facility | | $11,258.00 | $18,513.81 | $19,538.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,056.44 / $15,905.88 / $25,093.06
| Facility | | $10,056.44 | $15,905.88 | $25,093.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,083.68 / $12,298.52 / $25,307.25
| Facility | | $6,083.68 | $12,298.52 | $25,307.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,289.00 / $16,845.25 / $22,851.26
| Facility | | $6,289.00 | $16,845.25 | $22,851.26 |