- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,270.60 / $17,575.20 / $22,394.60
| Facility | | $11,270.60 | $17,575.20 | $22,394.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,618.46 / $11,618.46 / $18,057.59
| Facility | | $11,618.46 | $11,618.46 | $18,057.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,077.04 / $18,003.50 / $21,205.80
| Facility | | $10,077.04 | $18,003.50 | $21,205.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,592.95 / $18,258.41 / $25,578.69
| Facility | | $9,592.95 | $18,258.41 | $25,578.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,350.20 / $19,917.39 / $25,578.69
| Facility | | $17,350.20 | $19,917.39 | $25,578.69 |