- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $14,454.40 / $20,417.38
| Facility | | $6,025.60 | $14,454.40 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,079.46 / $7,079.46
| Facility | | $7,079.46 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $19,054.61 / $30,199.52
| Facility | | $12,302.69 | $19,054.61 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $14,454.40 / $30,199.52
| Facility | | $10,232.93 | $14,454.40 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $12,589.25 / $25,703.96
| Facility | | $8,912.51 | $12,589.25 | $25,703.96 |