- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,437.10 / $17,815.70 / $28,958.10
| Facility | | $10,437.10 | $17,815.70 | $28,958.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,640.00 / $10,658.67 / $12,744.52
| Facility | | $9,640.00 | $10,658.67 | $12,744.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,949.76 / $14,155.49 / $22,331.65
| Facility | | $8,949.76 | $14,155.49 | $22,331.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,149.39 / $11,990.28 / $22,522.27
| Facility | | $6,149.39 | $11,990.28 | $22,522.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,289.00 / $14,991.48 / $20,336.55
| Facility | | $6,289.00 | $14,991.48 | $20,336.55 |