- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,426.00 / $9,371.25 / $15,212.50
| Facility | | $6,426.00 | $9,371.25 | $15,212.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,708.54 / $10,708.54 / $13,551.99
| Facility | | $10,708.54 | $10,708.54 | $13,551.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,226.66 / $18,803.66 / $24,107.27
| Facility | | $13,226.66 | $18,803.66 | $24,107.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,545.63 / $14,588.78 / $18,452.16
| Facility | | $7,545.63 | $14,588.78 | $18,452.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,704.46 / $10,078.10 / $16,115.30
| Facility | | $6,704.46 | $10,078.10 | $16,115.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,840.79 / $13,407.85 / $20,370.41
| Facility | | $7,840.79 | $13,407.85 | $20,370.41 |