- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,862.50 / $13,180.60 / $13,180.60
| Facility | | $11,862.50 | $13,180.60 | $13,180.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,175.68 / $11,175.68 / $19,709.61
| Facility | | $11,175.68 | $11,175.68 | $19,709.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,429.73 / $12,090.53 / $22,742.46
| Facility | | $7,429.73 | $12,090.53 | $22,742.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,895.33 / $14,879.75 / $22,806.99
| Facility | | $10,895.33 | $14,879.75 | $22,806.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $19,691.45 / $25,424.96
| Facility | | $6,965.00 | $19,691.45 | $25,424.96 |