- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $13,803.84 / $15,848.93
| Facility | | $10,715.19 | $13,803.84 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $14,454.40 / $17,782.79
| Facility | | $14,125.38 | $14,454.40 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $12,589.25 / $15,135.61
| Facility | | $10,715.19 | $12,589.25 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $15,848.93 / $19,952.62
| Facility | | $9,772.37 | $15,848.93 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $16,595.87 / $21,379.62
| Facility | | $16,218.10 | $16,595.87 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $15,848.93 / $20,417.38
| Facility | | $1,862.09 | $15,848.93 | $20,417.38 |