- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,440.87 / $9,966.36 / $14,111.30
| Facility | | $5,440.87 | $9,966.36 | $14,111.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,523.76 / $9,523.76 / $11,308.48
| Facility | | $9,523.76 | $9,523.76 | $11,308.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,403.21 / $8,667.29 / $13,623.63
| Facility | | $5,403.21 | $8,667.29 | $13,623.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,656.86 / $8,965.27 / $15,950.63
| Facility | | $5,656.86 | $8,965.27 | $15,950.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,199.79 / $8,458.71 / $18,861.65
| Facility | | $4,199.79 | $8,458.71 | $18,861.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $8,291.00 / $16,761.45
| Facility | | $3,308.00 | $8,291.00 | $16,761.45 |