- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,576.89 / $11,815.20 / $15,055.20
| Facility | | $7,576.89 | $11,815.20 | $15,055.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,732.11 / $18,732.11 / $18,732.11
| Facility | | $18,732.11 | $18,732.11 | $18,732.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,774.48 / $12,103.20 / $14,256.00
| Facility | | $6,774.48 | $12,103.20 | $14,256.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,449.04 / $12,274.56 / $17,195.75
| Facility | | $6,449.04 | $12,274.56 | $17,195.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,664.00 / $13,389.84 / $17,195.75
| Facility | | $11,664.00 | $13,389.84 | $17,195.75 |