- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,397.40 / $13,774.90 / $13,774.90
| Facility | | $12,397.40 | $13,774.90 | $13,774.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,724.68 / $5,724.68 / $5,724.68
| Facility | | $5,724.68 | $5,724.68 | $5,724.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,408.57 / $13,194.17 / $23,420.25
| Facility | | $7,408.57 | $13,194.17 | $23,420.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,386.64 / $15,542.00 / $23,835.45
| Facility | | $11,386.64 | $15,542.00 | $23,835.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $20,579.41 / $26,571.47
| Facility | | $6,965.00 | $20,579.41 | $26,571.47 |