- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $14,791.08 / $16,982.44
| Facility | | $11,481.54 | $14,791.08 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $18,197.01 / $18,197.01
| Facility | | $18,197.01 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $13,489.63 / $16,595.87
| Facility | | $11,748.98 | $13,489.63 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $16,595.87 / $20,892.96
| Facility | | $10,471.29 | $16,595.87 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $20,892.96 / $20,892.96
| Facility | | $20,892.96 | $20,892.96 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $15,488.17 / $19,952.62
| Facility | | $1,513.56 | $15,488.17 | $19,952.62 |