- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,661.95 / $15,897.60 / $21,325.20
| Facility | | $7,661.95 | $15,897.60 | $21,325.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,843.46 / $16,843.46 / $16,843.46
| Facility | | $16,843.46 | $16,843.46 | $16,843.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $30,148.40 / $35,847.85
| Facility | | $3,897.00 | $30,148.40 | $35,847.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,512.96 / $16,416.00 / $25,838.28
| Facility | | $13,512.96 | $16,416.00 | $25,838.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $19,560.00 / $25,614.14
| Facility | | $1,350.00 | $19,560.00 | $25,614.14 |