- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,289.90 / $12,544.40 / $12,544.40
| Facility | | $11,289.90 | $12,544.40 | $12,544.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,141.00 / $14,141.00 / $14,141.00
| Facility | | $14,141.00 | $14,141.00 | $14,141.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,718.82 / $9,805.49 / $19,613.81
| Facility | | $5,718.82 | $9,805.49 | $19,613.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,369.44 / $14,161.54 / $21,706.15
| Facility | | $10,369.44 | $14,161.54 | $21,706.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $15,910.41 / $24,197.75
| Facility | | $6,965.00 | $15,910.41 | $24,197.75 |