- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,233.80 / $17,517.70 / $22,321.40
| Facility | | $11,233.80 | $17,517.70 | $22,321.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,800.76 / $9,800.76 / $9,800.76
| Facility | | $9,800.76 | $9,800.76 | $9,800.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,846.96 / $17,944.68 / $21,136.50
| Facility | | $9,846.96 | $17,944.68 | $21,136.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,561.60 / $18,198.74 / $25,495.10
| Facility | | $9,561.60 | $18,198.74 | $25,495.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,293.50 / $19,852.30 / $25,495.10
| Facility | | $17,293.50 | $19,852.30 | $25,495.10 |