- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,071.70 / $14,801.90 / $22,852.80
| Facility | | $10,071.70 | $14,801.90 | $22,852.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,073.18 / $20,073.18 / $20,073.18
| Facility | | $20,073.18 | $20,073.18 | $20,073.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,885.88 / $19,740.86 / $25,308.79
| Facility | | $13,885.88 | $19,740.86 | $25,308.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,335.36 / $21,915.86 / $27,719.59
| Facility | | $11,335.36 | $21,915.86 | $27,719.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,071.70 / $15,139.70 / $24,209.10
| Facility | | $10,071.70 | $15,139.70 | $24,209.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,778.76 / $20,141.82 / $30,601.28
| Facility | | $11,778.76 | $20,141.82 | $30,601.28 |