- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,888.50 / $16,542.80 / $16,542.80
| Facility | | $14,888.50 | $16,542.80 | $16,542.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,236.18 / $11,236.18 / $11,236.18
| Facility | | $11,236.18 | $11,236.18 | $11,236.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,350.58 / $13,911.69 / $31,041.37
| Facility | | $9,350.58 | $13,911.69 | $31,041.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,674.63 / $18,675.43 / $28,624.86
| Facility | | $13,674.63 | $18,675.43 | $28,624.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $24,714.56 / $31,910.64
| Facility | | $6,965.00 | $24,714.56 | $31,910.64 |