- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $18,197.01 / $23,442.29
| Facility | | $12,302.69 | $18,197.01 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $7,762.47 / $16,595.87
| Facility | | $3,981.07 | $7,762.47 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $8,912.51 / $16,595.87
| Facility | | $6,456.54 | $8,912.51 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $8,912.51 / $16,595.87
| Facility | | $6,456.54 | $8,912.51 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $11,220.18 / $18,197.01
| Facility | | $4,786.30 | $11,220.18 | $18,197.01 |