- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,166.60 / $25,740.60 / $25,740.60
| Facility | | $23,166.60 | $25,740.60 | $25,740.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,211.06 / $23,211.06 / $23,211.06
| Facility | | $23,211.06 | $23,211.06 | $23,211.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,856.75 / $15,602.70 / $34,842.06
| Facility | | $8,856.75 | $15,602.70 | $34,842.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,927.00 / $28,341.27 / $44,540.29
| Facility | | $11,927.00 | $28,341.27 | $44,540.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $38,455.87 / $49,652.97
| Facility | | $6,965.00 | $38,455.87 | $49,652.97 |