- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,501.40 / $16,375.60 / $20,866.09
| Facility | | $10,501.40 | $16,375.60 | $20,866.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,966.40 / $13,966.40 / $22,883.87
| Facility | | $13,966.40 | $13,966.40 | $22,883.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,389.24 / $16,774.70 / $19,758.41
| Facility | | $9,389.24 | $16,774.70 | $19,758.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,938.19 / $17,012.20 / $23,832.85
| Facility | | $8,938.19 | $17,012.20 | $23,832.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,558.99 / $17,012.20 / $23,832.85
| Facility | | $8,558.99 | $17,012.20 | $23,832.85 |