- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,228.91 / $14,000.00 / $21,342.30
| Facility | | $8,228.91 | $14,000.00 | $21,342.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,961.82 / $14,534.60 / $23,376.54
| Facility | | $8,961.82 | $14,534.60 | $23,376.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,555.58 / $13,559.30 / $24,124.14
| Facility | | $8,555.58 | $13,559.30 | $24,124.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,444.46 / $12,801.74 / $28,526.84
| Facility | | $5,444.46 | $12,801.74 | $28,526.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $12,514.48 / $25,350.44
| Facility | | $3,308.00 | $12,514.48 | $25,350.44 |