- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,071.10 / $11,190.10 / $11,190.10
| Facility | | $10,071.10 | $11,190.10 | $11,190.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,631.64 / $10,631.64 / $10,631.64
| Facility | | $10,631.64 | $10,631.64 | $10,631.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,544.18 / $9,009.58 / $22,067.12
| Facility | | $5,544.18 | $9,009.58 | $22,067.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,249.94 / $13,112.85 / $19,580.00
| Facility | | $9,249.94 | $13,112.85 | $19,580.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $16,717.68 / $21,585.32
| Facility | | $6,965.00 | $16,717.68 | $21,585.32 |