- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,324.10 / $14,460.10 / $23,282.50
| Facility | | $6,324.10 | $14,460.10 | $23,282.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,938.53 / $10,938.53 / $10,938.53
| Facility | | $10,938.53 | $10,938.53 | $10,938.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.01 / $5,642.90 / $20,489.41
| Facility | | $1,474.01 | $5,642.90 | $20,489.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,467.21 / $15,118.92 / $21,417.77
| Facility | | $10,467.21 | $15,118.92 | $21,417.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,149.50 / $12,680.66 / $26,630.95
| Facility | | $9,149.50 | $12,680.66 | $26,630.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,590.43 / $12,680.66 / $26,974.80
| Facility | | $8,590.43 | $12,680.66 | $26,974.80 |