- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,219.40 / $13,171.50 / $26,767.90
| Facility | | $10,219.40 | $13,171.50 | $26,767.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,225.03 / $11,563.77 / $13,220.38
| Facility | | $9,225.03 | $11,563.77 | $13,220.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,157.29 / $14,439.26 / $18,778.88
| Facility | | $8,157.29 | $14,439.26 | $18,778.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,575.96 / $18,575.96 / $18,575.96
| Facility | | $18,575.96 | $18,575.96 | $18,575.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.00 / $13,120.12 / $18,445.18
| Facility | | $1,518.00 | $13,120.12 | $18,445.18 |