- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,601.70 / $21,973.20 / $30,405.20
| Facility | | $13,601.70 | $21,973.20 | $30,405.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,040.50 / $28,040.50 / $28,040.50
| Facility | | $28,040.50 | $28,040.50 | $28,040.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,496.06 / $20,191.78 / $30,590.98
| Facility | | $12,496.06 | $20,191.78 | $30,590.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,124.50 / $20,317.23 / $31,471.46
| Facility | | $13,124.50 | $20,317.23 | $31,471.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,944.97 / $19,525.71 / $30,645.79
| Facility | | $11,944.97 | $19,525.71 | $30,645.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,266.48 / $23,734.01 / $33,796.35
| Facility | | $10,266.48 | $23,734.01 | $33,796.35 |