- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $16,218.10 / $18,620.87
| Facility | | $12,589.25 | $16,218.10 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $10,964.78
| Facility | | $10,964.78 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $14,454.40 / $17,378.01
| Facility | | $12,302.69 | $14,454.40 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $18,620.87 / $22,908.68
| Facility | | $11,481.54 | $18,620.87 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $12,882.50 / $12,882.50
| Facility | | $12,882.50 | $12,882.50 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $18,197.01 / $23,988.33
| Facility | | $1,862.09 | $18,197.01 | $23,988.33 |