- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,409.90 / $11,566.50 / $11,566.50
| Facility | | $10,409.90 | $11,566.50 | $11,566.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,142.56 / $5,142.56 / $5,142.56
| Facility | | $5,142.56 | $5,142.56 | $5,142.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,585.62 / $6,975.71 / $17,588.79
| Facility | | $4,585.62 | $6,975.71 | $17,588.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,582.00 / $12,735.15 / $20,014.18
| Facility | | $8,582.00 | $12,735.15 | $20,014.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $17,280.14 / $22,311.56
| Facility | | $6,965.00 | $17,280.14 | $22,311.56 |