- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,895.61 / $17,376.09 / $26,488.90
| Facility | | $8,895.61 | $17,376.09 | $26,488.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,256.50 / $15,019.85 / $23,712.68
| Facility | | $9,256.50 | $15,019.85 | $23,712.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,618.74 / $10,618.74 / $10,618.74
| Facility | | $10,618.74 | $10,618.74 | $10,618.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,113.82 / $16,325.51 / $35,406.03
| Facility | | $6,113.82 | $16,325.51 | $35,406.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $15,532.32 / $31,463.65
| Facility | | $3,308.00 | $15,532.32 | $31,463.65 |