- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,765.60 / $20,101.80 / $26,420.70
| Facility | | $13,765.60 | $20,101.80 | $26,420.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,833.34 / $10,833.34 / $10,833.34
| Facility | | $10,833.34 | $10,833.34 | $10,833.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,641.73 / $15,489.66 / $25,987.10
| Facility | | $5,641.73 | $15,489.66 | $25,987.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,488.89 / $20,284.20 / $36,181.29
| Facility | | $14,488.89 | $20,284.20 | $36,181.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,315.21 / $22,533.59 / $32,900.87
| Facility | | $17,315.21 | $22,533.59 | $32,900.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,315.21 / $20,947.98 / $32,900.87
| Facility | | $17,315.21 | $20,947.98 | $32,900.87 |