- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,452.60 / $15,957.60 / $28,080.70
| Facility | | $9,452.60 | $15,957.60 | $28,080.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,489.02 / $12,271.47 / $19,998.96
| Facility | | $8,489.02 | $12,271.47 | $19,998.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,598.62 / $14,708.97 / $20,310.45
| Facility | | $8,598.62 | $14,708.97 | $20,310.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,884.05 / $29,884.05 / $35,071.47
| Facility | | $29,884.05 | $29,884.05 | $35,071.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $13,906.87 / $19,864.38
| Facility | | $1,787.00 | $13,906.87 | $19,864.38 |