- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,510.30 / $11,678.10 / $11,678.10
| Facility | | $10,510.30 | $11,678.10 | $11,678.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,211.73 / $10,211.73 / $10,211.73
| Facility | | $10,211.73 | $10,211.73 | $10,211.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,642.56 / $5,982.27 / $13,814.91
| Facility | | $3,642.56 | $5,982.27 | $13,814.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,550.00 / $13,176.00 / $20,207.20
| Facility | | $8,550.00 | $13,176.00 | $20,207.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $17,446.80 / $22,526.74
| Facility | | $6,965.00 | $17,446.80 | $22,526.74 |