- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,709.60 / $13,803.20 / $28,051.80
| Facility | | $10,709.60 | $13,803.20 | $28,051.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,249.59 / $21,249.59 / $21,249.59
| Facility | | $21,249.59 | $21,249.59 | $21,249.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,266.99 / $14,123.41 / $16,146.71
| Facility | | $11,266.99 | $14,123.41 | $16,146.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,548.54 / $15,131.81 / $19,679.58
| Facility | | $8,548.54 | $15,131.81 | $19,679.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,437.03 / $24,437.03 / $24,437.03
| Facility | | $24,437.03 | $24,437.03 | $24,437.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.00 / $13,749.40 / $19,329.86
| Facility | | $1,518.00 | $13,749.40 | $19,329.86 |