- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,619.70 / $19,678.90 / $25,075.30
| Facility | | $12,619.70 | $19,678.90 | $25,075.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,767.01 / $6,767.01 / $6,767.01
| Facility | | $6,767.01 | $6,767.01 | $6,767.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,010.49 / $20,158.55 / $23,744.16
| Facility | | $10,010.49 | $20,158.55 | $23,744.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,741.23 / $20,443.96 / $28,640.49
| Facility | | $10,741.23 | $20,443.96 | $28,640.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,427.04 / $22,301.52 / $28,640.49
| Facility | | $19,427.04 | $22,301.52 | $28,640.49 |