- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $15,135.61 / $17,378.01
| Facility | | $11,748.98 | $15,135.61 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $13,182.57 / $18,620.87
| Facility | | $13,182.57 | $13,182.57 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $13,182.57 / $15,848.93
| Facility | | $11,220.18 | $13,182.57 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $16,982.44 / $21,379.62
| Facility | | $10,715.19 | $16,982.44 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $15,135.61 / $21,379.62
| Facility | | $15,135.61 | $15,135.61 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $16,982.44 / $22,387.21
| Facility | | $1,862.09 | $16,982.44 | $22,387.21 |