- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,588.60 / $20,882.40 / $28,022.50
| Facility | | $12,588.60 | $20,882.40 | $28,022.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,835.29 / $7,835.29 / $7,835.29
| Facility | | $7,835.29 | $7,835.29 | $7,835.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,336.94 / $18,004.71 / $27,839.59
| Facility | | $10,336.94 | $18,004.71 | $27,839.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,336.94 / $16,813.50 / $38,560.08
| Facility | | $10,336.94 | $16,813.50 | $38,560.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,272.73 / $16,562.41 / $23,751.87
| Facility | | $12,272.73 | $16,562.41 | $23,751.87 |