- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,409.20 / $14,899.20 / $14,899.20
| Facility | | $13,409.20 | $14,899.20 | $14,899.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,804.62 / $9,804.62 / $9,804.62
| Facility | | $9,804.62 | $9,804.62 | $9,804.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,671.25 / $10,571.64 / $22,753.56
| Facility | | $6,671.25 | $10,571.64 | $22,753.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,315.96 / $16,819.90 / $25,780.77
| Facility | | $12,315.96 | $16,819.90 | $25,780.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $22,258.99 / $28,740.09
| Facility | | $6,965.00 | $22,258.99 | $28,740.09 |