- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,452.20 / $11,613.60 / $11,613.60
| Facility | | $10,452.20 | $11,613.60 | $11,613.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,507.40 / $5,507.40 / $5,507.40
| Facility | | $5,507.40 | $5,507.40 | $5,507.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,027.54 / $5,528.56 / $9,693.78
| Facility | | $3,027.54 | $5,528.56 | $9,693.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,600.04 / $13,609.18 / $20,095.61
| Facility | | $9,600.04 | $13,609.18 | $20,095.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $17,350.45 / $22,402.34
| Facility | | $6,965.00 | $17,350.45 | $22,402.34 |