- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,602.50 / $20,109.50 / $40,867.90
| Facility | | $15,602.50 | $20,109.50 | $40,867.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,936.86 / $13,936.86 / $13,936.86
| Facility | | $13,936.86 | $13,936.86 | $13,936.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,896.83 / $17,419.97 / $19,915.53
| Facility | | $13,896.83 | $17,419.97 | $19,915.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,454.16 / $22,045.16 / $28,670.69
| Facility | | $12,454.16 | $22,045.16 | $28,670.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.00 / $20,031.16 / $28,161.20
| Facility | | $1,518.00 | $20,031.16 | $28,161.20 |