- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,420.50 / $27,165.20 / $34,614.40
| Facility | | $17,420.50 | $27,165.20 | $34,614.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,206.62 / $22,206.62 / $22,206.62
| Facility | | $22,206.62 | $22,206.62 | $22,206.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,641.08 / $27,827.27 / $32,776.92
| Facility | | $14,641.08 | $27,827.27 | $32,776.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,827.42 / $28,221.26 / $39,535.92
| Facility | | $14,827.42 | $28,221.26 | $39,535.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,817.48 / $30,785.47 / $39,535.92
| Facility | | $26,817.48 | $30,785.47 | $39,535.92 |