- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,638.60 / $15,514.60 / $25,185.10
| Facility | | $10,638.60 | $15,514.60 | $25,185.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,984.22 / $20,984.22 / $25,479.45
| Facility | | $20,984.22 | $20,984.22 | $25,479.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,200.65 / $30,139.89 / $38,640.89
| Facility | | $21,200.65 | $30,139.89 | $38,640.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,492.22 / $24,152.53 / $30,548.58
| Facility | | $12,492.22 | $24,152.53 | $30,548.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,099.60 / $16,684.90 / $26,679.80
| Facility | | $11,099.60 | $16,684.90 | $26,679.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,980.87 / $22,197.44 / $33,724.36
| Facility | | $12,980.87 | $22,197.44 | $33,724.36 |