- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,560.50 / $11,733.90 / $11,733.90
| Facility | | $10,560.50 | $11,733.90 | $11,733.90 |
- 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
- $5,178.82 / $8,288.20 / $16,557.56
| Facility | | $5,178.82 | $8,288.20 | $16,557.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,699.46 / $13,750.11 / $20,805.25
| Facility | | $9,699.46 | $13,750.11 | $20,805.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $17,530.13 / $22,634.33
| Facility | | $6,965.00 | $17,530.13 | $22,634.33 |