- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,592.30 / $22,880.40 / $22,880.40
| Facility | | $20,592.30 | $22,880.40 | $22,880.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,486.27 / $9,486.27 / $9,486.27
| Facility | | $9,486.27 | $9,486.27 | $9,486.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,763.74 / $15,408.05 / $34,634.66
| Facility | | $9,763.74 | $15,408.05 | $34,634.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,709.95 / $25,391.37 / $39,591.03
| Facility | | $17,709.95 | $25,391.37 | $39,591.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,296.68 / $34,182.71 / $44,135.60
| Facility | | $19,296.68 | $34,182.71 | $44,135.60 |