- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,502.80 / $22,398.80 / $30,057.50
| Facility | | $13,502.80 | $22,398.80 | $30,057.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,423.65 / $23,423.65 / $23,423.65
| Facility | | $23,423.65 | $23,423.65 | $23,423.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,959.40 / $18,499.46 / $29,599.85
| Facility | | $10,959.40 | $18,499.46 | $29,599.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,087.61 / $18,034.50 / $41,360.32
| Facility | | $11,087.61 | $18,034.50 | $41,360.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,085.83 / $17,765.18 / $25,166.54
| Facility | | $13,085.83 | $17,765.18 | $25,166.54 |