- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,076.20 / $18,142.30 / $36,869.90
| Facility | | $14,076.20 | $18,142.30 | $36,869.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,200.68 / $27,200.68 / $27,200.68
| Facility | | $27,200.68 | $27,200.68 | $27,200.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,359.36 / $16,746.24 / $19,145.28
| Facility | | $13,359.36 | $16,746.24 | $19,145.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,235.80 / $19,888.54 / $25,865.90
| Facility | | $11,235.80 | $19,888.54 | $25,865.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.00 / $18,071.56 / $25,406.26
| Facility | | $1,518.00 | $18,071.56 | $25,406.26 |