- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,841.30 / $12,045.90 / $12,045.90
| Facility | | $10,841.30 | $12,045.90 | $12,045.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,567.39 / $5,567.39 / $5,567.39
| Facility | | $5,567.39 | $5,567.39 | $5,567.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,714.68 / $7,238.84 / $16,663.24
| Facility | | $4,714.68 | $7,238.84 | $16,663.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,957.37 / $14,115.72 / $20,843.58
| Facility | | $9,957.37 | $14,115.72 | $20,843.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $17,996.24 / $23,236.16
| Facility | | $6,965.00 | $17,996.24 | $23,236.16 |