- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,158.29 / $15,840.60 / $20,184.40
| Facility | | $10,158.29 | $15,840.60 | $20,184.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,371.63 / $25,371.63 / $25,371.63
| Facility | | $25,371.63 | $25,371.63 | $25,371.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,031.28 / $16,226.69 / $19,112.93
| Facility | | $9,031.28 | $16,226.69 | $19,112.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,646.19 / $16,456.43 / $23,054.26
| Facility | | $8,646.19 | $16,456.43 | $23,054.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,637.86 / $17,951.68 / $23,054.26
| Facility | | $15,637.86 | $17,951.68 | $23,054.26 |