- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,319.70 / $12,577.50 / $12,577.50
| Facility | | $11,319.70 | $12,577.50 | $12,577.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,146.20 / $14,141.00 / $19,636.96
| Facility | | $11,146.20 | $14,141.00 | $19,636.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,335.59 / $5,293.59 / $9,832.10
| Facility | | $3,335.59 | $5,293.59 | $9,832.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,396.81 / $14,198.92 / $21,763.46
| Facility | | $10,396.81 | $14,198.92 | $21,763.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $18,790.46 / $24,261.64
| Facility | | $6,965.00 | $18,790.46 | $24,261.64 |