- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,972.10 / $27,746.80 / $27,746.80
| Facility | | $24,972.10 | $27,746.80 | $27,746.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,584.80 / $35,584.80 / $35,584.80
| Facility | | $35,584.80 | $35,584.80 | $35,584.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,611.11 / $20,516.25 / $37,350.80
| Facility | | $13,611.11 | $20,516.25 | $37,350.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,316.68 / $30,550.15 / $48,011.70
| Facility | | $17,316.68 | $30,550.15 | $48,011.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $41,453.08 / $53,522.86
| Facility | | $6,965.00 | $41,453.08 | $53,522.86 |