- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,674.70 / $19,772.90 / $26,520.20
| Facility | | $11,674.70 | $19,772.90 | $26,520.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,839.25 / $20,839.25 / $20,839.25
| Facility | | $20,839.25 | $20,839.25 | $20,839.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,749.61 / $21,320.12 / $25,112.34
| Facility | | $11,749.61 | $21,320.12 | $25,112.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,360.16 / $21,621.98 / $30,290.81
| Facility | | $11,360.16 | $21,621.98 | $30,290.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,546.46 / $23,586.58 / $30,290.81
| Facility | | $20,546.46 | $23,586.58 | $30,290.81 |