- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,686.40 / $19,687.80 / $31,517.20
| Facility | | $12,686.40 | $19,687.80 | $31,517.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,758.20 / $19,758.20 / $19,758.20
| Facility | | $19,758.20 | $19,758.20 | $19,758.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,935.01 / $15,358.35 / $21,905.75
| Facility | | $7,935.01 | $15,358.35 | $21,905.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,723.13 / $15,705.54 / $27,518.20
| Facility | | $11,723.13 | $15,705.54 | $27,518.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,511.16 / $20,655.05 / $24,356.71
| Facility | | $11,511.16 | $20,655.05 | $24,356.71 |