- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,670.20 / $19,757.70 / $25,175.60
| Facility | | $12,670.20 | $19,757.70 | $25,175.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,029.26 / $38,029.26 / $38,029.26
| Facility | | $38,029.26 | $38,029.26 | $38,029.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,328.44 / $20,239.24 / $23,839.20
| Facility | | $11,328.44 | $20,239.24 | $23,839.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,784.23 / $20,525.79 / $28,755.13
| Facility | | $10,784.23 | $20,525.79 | $28,755.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,504.80 / $22,390.79 / $28,755.13
| Facility | | $19,504.80 | $22,390.79 | $28,755.13 |