- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $16,218.10 / $21,877.62
| Facility | | $6,309.57 | $16,218.10 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $16,595.87 / $16,595.87
| Facility | | $16,595.87 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $20,417.38 / $23,442.29
| Facility | | $14,791.08 | $20,417.38 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $16,982.44 / $23,988.33
| Facility | | $13,803.84 | $16,982.44 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $6,309.57 / $20,892.96
| Facility | | $1,819.70 | $6,309.57 | $20,892.96 |