- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $14,125.38 / $24,547.09
| Facility | | $14,125.38 | $14,125.38 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $25,118.86 / $37,153.52
| Facility | | $18,620.87 | $25,118.86 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $19,498.45 / $25,703.96
| Facility | | $10,232.93 | $19,498.45 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $12,589.25 / $19,498.45
| Facility | | $8,912.51 | $12,589.25 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,547.09 / $24,547.09 / $43,651.58
| Facility | | $24,547.09 | $24,547.09 | $43,651.58 |