- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $19,952.62 / $25,703.96
| Facility | | $13,489.63 | $19,952.62 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $8,511.38 / $18,197.01
| Facility | | $4,570.88 | $8,511.38 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $9,772.37 / $18,197.01
| Facility | | $7,079.46 | $9,772.37 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $9,772.37 / $18,197.01
| Facility | | $7,079.46 | $9,772.37 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $12,589.25 / $19,952.62
| Facility | | $5,248.07 | $12,589.25 | $19,952.62 |