- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $13,803.84 / $20,892.96
| Facility | | $10,715.19 | $13,803.84 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $12,589.25
| Facility | | $11,220.18 | $11,220.18 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $13,489.63 / $19,952.62
| Facility | | $6,918.31 | $13,489.63 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $10,964.78 / $19,952.62
| Facility | | $7,762.47 | $10,964.78 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $10,000.00 / $16,595.87
| Facility | | $3,311.31 | $10,000.00 | $16,595.87 |