- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,642.99 / $14,000.10 / $19,822.70
| Facility | | $7,642.99 | $14,000.10 | $19,822.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,621.00 / $12,305.39 / $16,146.22
| Facility | | $11,621.00 | $12,305.39 | $16,146.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,384.87 / $13,487.10 / $21,552.26
| Facility | | $8,384.87 | $13,487.10 | $21,552.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,538.00 / $12,047.22 / $22,406.44
| Facility | | $7,538.00 | $12,047.22 | $22,406.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,264.00 / $11,818.80 / $26,495.66
| Facility | | $5,264.00 | $11,818.80 | $26,495.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $11,623.42 / $23,545.42
| Facility | | $3,308.00 | $11,623.42 | $23,545.42 |