- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,766.80 / $21,467.60 / $27,354.50
| Facility | | $13,766.80 | $21,467.60 | $27,354.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,146.83 / $34,146.83 / $34,146.83
| Facility | | $34,146.83 | $34,146.83 | $34,146.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,308.85 / $21,990.84 / $25,902.36
| Facility | | $12,308.85 | $21,990.84 | $25,902.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,717.55 / $22,302.19 / $31,243.74
| Facility | | $11,717.55 | $22,302.19 | $31,243.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,192.84 / $24,328.60 / $31,243.74
| Facility | | $21,192.84 | $24,328.60 | $31,243.74 |