- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $30,902.95 / $39,810.72
| Facility | | $20,892.96 | $30,902.95 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $13,182.57 / $28,183.83
| Facility | | $6,760.83 | $13,182.57 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $15,135.61 / $28,183.83
| Facility | | $10,964.78 | $15,135.61 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $15,135.61 / $28,183.83
| Facility | | $10,964.78 | $15,135.61 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $19,054.61 / $30,902.95
| Facility | | $5,370.32 | $19,054.61 | $30,902.95 |