- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,163.50 / $22,086.30 / $28,142.80
| Facility | | $14,163.50 | $22,086.30 | $28,142.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,444.37 / $30,444.37 / $30,444.37
| Facility | | $30,444.37 | $30,444.37 | $30,444.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,419.09 / $22,624.58 / $26,648.82
| Facility | | $12,419.09 | $22,624.58 | $26,648.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,055.23 / $22,944.90 / $32,144.13
| Facility | | $12,055.23 | $22,944.90 | $32,144.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,803.58 / $25,029.70 / $32,144.13
| Facility | | $21,803.58 | $25,029.70 | $32,144.13 |