- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,058.60 / $20,363.20 / $25,947.20
| Facility | | $13,058.60 | $20,363.20 | $25,947.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,202.33 / $30,202.33 / $30,202.33
| Facility | | $30,202.33 | $30,202.33 | $30,202.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,574.17 / $20,859.53 / $24,569.82
| Facility | | $10,574.17 | $20,859.53 | $24,569.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,114.74 / $21,154.86 / $29,636.41
| Facility | | $11,114.74 | $21,154.86 | $29,636.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,554.75 / $20,849.59 / $29,636.41
| Facility | | $10,554.75 | $20,849.59 | $29,636.41 |