- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $13,489.63 / $18,197.01
| Facility | | $5,370.32 | $13,489.63 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $14,791.08 / $19,498.45
| Facility | | $11,748.98 | $14,791.08 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $17,782.79 / $19,952.62
| Facility | | $12,882.50 | $17,782.79 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $14,454.40 / $19,952.62
| Facility | | $11,481.54 | $14,454.40 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $6,309.57 / $17,782.79
| Facility | | $1,819.70 | $6,309.57 | $17,782.79 |