- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,950.80 / $24,389.80 / $24,389.80
| Facility | | $21,950.80 | $24,389.80 | $24,389.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,073.98 / $16,073.98 / $16,073.98
| Facility | | $16,073.98 | $16,073.98 | $16,073.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,371.38 / $26,049.16 / $46,877.84
| Facility | | $14,371.38 | $26,049.16 | $46,877.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,221.59 / $27,534.03 / $42,202.89
| Facility | | $15,221.59 | $27,534.03 | $42,202.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,569.71 / $36,437.76 / $47,047.26
| Facility | | $20,569.71 | $36,437.76 | $47,047.26 |