- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,952.50 / $26,613.90 / $26,613.90
| Facility | | $23,952.50 | $26,613.90 | $26,613.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,080.70 / $18,080.70 / $19,371.90
| Facility | | $18,080.70 | $18,080.70 | $19,371.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,461.25 / $16,316.46 / $36,165.85
| Facility | | $9,461.25 | $16,316.46 | $36,165.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,609.62 / $29,302.74 / $46,051.30
| Facility | | $16,609.62 | $29,302.74 | $46,051.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $39,760.48 / $51,337.43
| Facility | | $6,965.00 | $39,760.48 | $51,337.43 |