- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,815.62 / $16,754.90 / $27,233.70
| Facility | | $9,815.62 | $16,754.90 | $27,233.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,280.00 / $10,280.00 / $18,495.91
| Facility | | $10,280.00 | $10,280.00 | $18,495.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,416.83 / $13,312.58 / $21,001.89
| Facility | | $8,416.83 | $13,312.58 | $21,001.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,271.78 / $13,000.84 / $24,281.80
| Facility | | $7,271.78 | $13,000.84 | $24,281.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,164.00 / $13,904.25 / $19,296.82
| Facility | | $6,164.00 | $13,904.25 | $19,296.82 |