- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $10,964.78 / $15,488.17
| Facility | | $6,760.83 | $10,964.78 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $20,892.96 / $20,892.96
| Facility | | $20,892.96 | $20,892.96 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $11,220.18 / $15,488.17
| Facility | | $7,079.46 | $11,220.18 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $6,760.83
| Facility | | $6,760.83 | $6,760.83 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $7,943.28 / $16,982.44
| Facility | | $2,187.76 | $7,943.28 | $16,982.44 |