- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $10,715.19 / $14,791.08
| Facility | | $5,754.40 | $10,715.19 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $8,317.64 / $8,317.64
| Facility | | $8,317.64 | $8,317.64 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,000.00 / $16,595.87
| Facility | | $6,606.93 | $10,000.00 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $11,481.54 / $15,848.93
| Facility | | $5,623.41 | $11,481.54 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $8,511.38 / $17,378.01
| Facility | | $4,168.69 | $8,511.38 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,317.64 / $16,595.87
| Facility | | $3,548.13 | $8,317.64 | $16,595.87 |