- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,993.30 / $15,886.80 / $27,795.80
| Facility | | $11,993.30 | $15,886.80 | $27,795.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,166.50 / $22,729.91 / $29,248.32
| Facility | | $7,166.50 | $22,729.91 | $29,248.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,939.30 / $13,047.34 / $29,250.57
| Facility | | $5,939.30 | $13,047.34 | $29,250.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,380.65 / $16,135.45 / $24,816.83
| Facility | | $11,380.65 | $16,135.45 | $24,816.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $16,372.09 / $28,122.73
| Facility | | $3,496.00 | $16,372.09 | $28,122.73 |