- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,828.70 / $15,813.20 / $22,890.10
| Facility | | $10,828.70 | $15,813.20 | $22,890.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,644.59 / $23,542.48 / $39,818.94
| Facility | | $8,644.59 | $23,542.48 | $39,818.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,000.50 / $15,883.42 / $26,585.26
| Facility | | $11,000.50 | $15,883.42 | $26,585.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,621.06 / $17,726.11 / $25,881.57
| Facility | | $13,621.06 | $17,726.11 | $25,881.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,621.06 / $16,478.78 / $25,881.57
| Facility | | $13,621.06 | $16,478.78 | $25,881.57 |