- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,889.08 / $10,987.90 / $10,987.90
| Facility | | $9,889.08 | $10,987.90 | $10,987.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,506.03 / $11,506.03 / $11,506.03
| Facility | | $11,506.03 | $11,506.03 | $11,506.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,281.93 / $9,978.12 / $17,517.47
| Facility | | $6,281.93 | $9,978.12 | $17,517.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,082.79 / $12,404.38 / $19,012.86
| Facility | | $9,082.79 | $12,404.38 | $19,012.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $16,415.62 / $21,195.31
| Facility | | $6,965.00 | $16,415.62 | $21,195.31 |