- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,650.79 / $14,766.60 / $24,001.90
| Facility | | $8,650.79 | $14,766.60 | $24,001.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,258.00 / $11,258.00 / $14,718.47
| Facility | | $11,258.00 | $11,258.00 | $14,718.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,418.00 / $11,732.76 / $18,509.56
| Facility | | $7,418.00 | $11,732.76 | $18,509.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,797.84 / $10,550.27 / $21,182.02
| Facility | | $4,797.84 | $10,550.27 | $21,182.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,164.00 / $12,425.67 / $16,875.05
| Facility | | $6,164.00 | $12,425.67 | $16,875.05 |