- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,667.50 / $20,741.70 / $20,741.70
| Facility | | $18,667.50 | $20,741.70 | $20,741.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,273.11 / $16,699.03 / $31,278.47
| Facility | | $15,273.11 | $16,699.03 | $31,278.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,005.86 / $12,481.53 / $25,685.37
| Facility | | $6,005.86 | $12,481.53 | $25,685.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,510.00 / $22,837.29 / $35,890.40
| Facility | | $10,510.00 | $22,837.29 | $35,890.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $30,987.60 / $40,010.18
| Facility | | $6,965.00 | $30,987.60 | $40,010.18 |