- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $11,481.54 / $18,620.87
| Facility | | $5,623.41 | $11,481.54 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,748.98
| Facility | | $11,220.18 | $11,220.18 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $14,791.08 / $23,442.29
| Facility | | $9,332.54 | $14,791.08 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $10,000.00 / $33,884.42
| Facility | | $5,370.32 | $10,000.00 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $9,549.93 / $15,135.61
| Facility | | $5,370.32 | $9,549.93 | $15,135.61 |