- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,183.83 / $41,686.94 / $53,703.18
| Facility | | $28,183.83 | $41,686.94 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $17,782.79 / $38,018.94
| Facility | | $9,549.93 | $17,782.79 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $20,417.38 / $38,018.94
| Facility | | $14,791.08 | $20,417.38 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $20,417.38 / $38,018.94
| Facility | | $14,791.08 | $20,417.38 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $25,703.96 / $41,686.94
| Facility | | $5,370.32 | $25,703.96 | $41,686.94 |