- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,788.17 / $16,097.80 / $22,792.80
| Facility | | $8,788.17 | $16,097.80 | $22,792.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,783.33 / $17,142.27 / $27,130.19
| Facility | | $10,783.33 | $17,142.27 | $27,130.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,137.04 / $18,495.58 / $33,527.40
| Facility | | $9,137.04 | $18,495.58 | $33,527.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,814.48 / $14,184.57 / $30,465.60
| Facility | | $5,814.48 | $14,184.57 | $30,465.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $13,365.00 / $27,073.33
| Facility | | $3,308.00 | $13,365.00 | $27,073.33 |