- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,568.40 / $18,039.59 / $22,986.40
| Facility | | $11,568.40 | $18,039.59 | $22,986.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,078.75 / $14,078.75 / $14,078.75
| Facility | | $14,078.75 | $14,078.75 | $14,078.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,338.50 / $18,479.23 / $21,766.14
| Facility | | $10,338.50 | $18,479.23 | $21,766.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,846.43 / $18,740.87 / $26,254.58
| Facility | | $9,846.43 | $18,740.87 | $26,254.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,808.66 / $20,443.68 / $26,254.58
| Facility | | $17,808.66 | $20,443.68 | $26,254.58 |