- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,559.80 / $15,066.50 / $15,066.50
| Facility | | $13,559.80 | $15,066.50 | $15,066.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,877.52 / $16,877.52 / $16,877.52
| Facility | | $16,877.52 | $16,877.52 | $16,877.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,256.05 / $12,915.90 / $22,410.50
| Facility | | $7,256.05 | $12,915.90 | $22,410.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,402.94 / $16,588.70 / $26,070.30
| Facility | | $9,402.94 | $16,588.70 | $26,070.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $22,508.98 / $29,062.86
| Facility | | $6,965.00 | $22,508.98 | $29,062.86 |