- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,923.20 / $16,656.20 / $33,849.80
| Facility | | $12,923.20 | $16,656.20 | $33,849.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,392.50 / $18,392.50 / $18,392.50
| Facility | | $18,392.50 | $18,392.50 | $18,392.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,920.58 / $16,196.22 / $18,516.47
| Facility | | $12,920.58 | $16,196.22 | $18,516.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,315.45 / $18,259.43 / $23,747.17
| Facility | | $10,315.45 | $18,259.43 | $23,747.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,151.38 / $21,151.38 / $21,151.38
| Facility | | $21,151.38 | $21,151.38 | $21,151.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.00 / $16,591.28 / $23,325.18
| Facility | | $1,518.00 | $16,591.28 | $23,325.18 |