- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $23,988.33 / $30,902.95
| Facility | | $16,218.10 | $23,988.33 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $10,232.93 / $21,877.62
| Facility | | $5,248.07 | $10,232.93 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $11,748.98 / $21,877.62
| Facility | | $8,511.38 | $11,748.98 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $11,748.98 / $21,877.62
| Facility | | $8,511.38 | $11,748.98 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $15,135.61 / $23,988.33
| Facility | | $5,370.32 | $15,135.61 | $23,988.33 |