- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,800.80 / $18,667.50 / $18,667.50
| Facility | | $16,800.80 | $18,667.50 | $18,667.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,177.89 / $17,177.89 / $17,177.89
| Facility | | $17,177.89 | $17,177.89 | $17,177.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,357.15 / $12,086.97 / $30,525.73
| Facility | | $7,357.15 | $12,086.97 | $30,525.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,430.97 / $21,489.00 / $32,301.36
| Facility | | $15,430.97 | $21,489.00 | $32,301.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $27,888.84 / $36,009.16
| Facility | | $6,965.00 | $27,888.84 | $36,009.16 |