- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,017.90 / $15,058.80 / $22,730.70
| Facility | | $10,017.90 | $15,058.80 | $22,730.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,780.50 / $17,780.50 / $17,780.50
| Facility | | $17,780.50 | $17,780.50 | $17,780.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,401.79 / $29,004.19 / $37,184.86
| Facility | | $20,401.79 | $29,004.19 | $37,184.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,235.35 / $21,798.71 / $27,571.42
| Facility | | $12,235.35 | $21,798.71 | $27,571.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,017.90 / $15,202.80 / $23,076.30
| Facility | | $10,017.90 | $15,202.80 | $23,076.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,715.80 / $19,155.59 / $32,074.81
| Facility | | $11,715.80 | $19,155.59 | $32,074.81 |