- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $15,488.17 / $17,782.79
| Facility | | $12,022.64 | $15,488.17 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $11,748.98 / $11,748.98
| Facility | | $11,748.98 | $11,748.98 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $14,791.08 / $17,782.79
| Facility | | $12,589.25 | $14,791.08 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $17,378.01 / $21,877.62
| Facility | | $10,964.78 | $17,378.01 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $13,489.63 / $13,489.63
| Facility | | $13,489.63 | $13,489.63 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $16,218.10 / $20,892.96
| Facility | | $1,513.56 | $16,218.10 | $20,892.96 |