- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,551.90 / $16,454.40 / $20,966.50
| Facility | | $10,551.90 | $16,454.40 | $20,966.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,924.27 / $25,924.27 / $25,924.27
| Facility | | $25,924.27 | $25,924.27 | $25,924.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,434.40 / $16,855.39 / $19,853.46
| Facility | | $9,434.40 | $16,855.39 | $19,853.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,981.18 / $17,094.03 / $23,947.48
| Facility | | $8,981.18 | $17,094.03 | $23,947.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,356.28 / $18,647.21 / $23,947.48
| Facility | | $16,356.28 | $18,647.21 | $23,947.48 |