- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,670.10 / $15,881.50 / $22,486.50
| Facility | | $8,670.10 | $15,881.50 | $22,486.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,319.86 / $9,319.86 / $12,944.88
| Facility | | $9,319.86 | $9,319.86 | $12,944.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,208.19 / $14,811.41 / $23,668.50
| Facility | | $9,208.19 | $14,811.41 | $23,668.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,014.28 / $14,286.27 / $25,417.54
| Facility | | $9,014.28 | $14,286.27 | $25,417.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,736.36 / $13,185.43 / $30,056.29
| Facility | | $5,736.36 | $13,185.43 | $30,056.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $13,185.43 / $26,709.58
| Facility | | $3,308.00 | $13,185.43 | $26,709.58 |