- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,744.50 / $16,754.70 / $21,349.10
| Facility | | $10,744.50 | $16,754.70 | $21,349.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,264.93 / $14,264.93 / $14,264.93
| Facility | | $14,264.93 | $14,264.93 | $14,264.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,606.59 / $17,163.00 / $20,215.80
| Facility | | $9,606.59 | $17,163.00 | $20,215.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,145.10 / $17,406.00 / $24,384.54
| Facility | | $9,145.10 | $17,406.00 | $24,384.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,540.20 / $18,987.54 / $24,384.54
| Facility | | $16,540.20 | $18,987.54 | $24,384.54 |