- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $17,782.79 / $21,877.62
| Facility | | $6,760.83 | $17,782.79 | $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
- $13,489.63 / $21,379.62 / $33,884.42
| Facility | | $13,489.63 | $21,379.62 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $15,488.17 / $28,840.32
| Facility | | $10,715.19 | $15,488.17 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $16,595.87 / $33,884.42
| Facility | | $10,715.19 | $16,595.87 | $33,884.42 |