- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,055.60 / $14,644.60 / $25,622.50
| Facility | | $11,055.60 | $14,644.60 | $25,622.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,007.22 / $11,007.22 / $11,007.22
| Facility | | $11,007.22 | $11,007.22 | $11,007.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,843.91 / $12,377.41 / $24,003.95
| Facility | | $5,843.91 | $12,377.41 | $24,003.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,074.68 / $14,873.84 / $22,876.43
| Facility | | $10,074.68 | $14,873.84 | $22,876.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $15,091.97 / $22,958.00
| Facility | | $3,496.00 | $15,091.97 | $22,958.00 |