- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $16,595.87 / $22,387.21
| Facility | | $11,220.18 | $16,595.87 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,442.29 / $23,442.29 / $23,442.29
| Facility | | $23,442.29 | $23,442.29 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $16,595.87 / $21,877.62
| Facility | | $7,943.28 | $16,595.87 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $14,791.08 / $21,877.62
| Facility | | $9,549.93 | $14,791.08 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $15,135.61 / $21,379.62
| Facility | | $6,165.95 | $15,135.61 | $21,379.62 |