- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,798.90 / $11,998.80 / $11,998.80
| Facility | | $10,798.90 | $11,998.80 | $11,998.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,678.71 / $5,678.71 / $12,298.38
| Facility | | $5,678.71 | $5,678.71 | $12,298.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,384.34 / $7,460.62 / $18,468.48
| Facility | | $4,384.34 | $7,460.62 | $18,468.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,918.46 / $14,060.57 / $20,762.14
| Facility | | $9,918.46 | $14,060.57 | $20,762.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $17,925.93 / $23,145.38
| Facility | | $6,965.00 | $17,925.93 | $23,145.38 |