- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,729.60 / $15,768.80 / $24,345.70
| Facility | | $10,729.60 | $15,768.80 | $24,345.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,127.17 / $27,127.17 / $27,127.17
| Facility | | $27,127.17 | $27,127.17 | $27,127.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,769.15 / $32,369.74 / $41,499.67
| Facility | | $22,769.15 | $32,369.74 | $41,499.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,075.83 / $23,347.49 / $29,530.35
| Facility | | $12,075.83 | $23,347.49 | $29,530.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,729.60 / $16,128.70 / $25,790.60
| Facility | | $10,729.60 | $16,128.70 | $25,790.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,548.19 / $21,457.57 / $32,600.28
| Facility | | $12,548.19 | $21,457.57 | $32,600.28 |