- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $20,892.96 / $26,915.35
| Facility | | $14,125.38 | $20,892.96 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $8,912.51 / $19,054.61
| Facility | | $4,786.30 | $8,912.51 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $10,232.93 / $19,054.61
| Facility | | $7,413.10 | $10,232.93 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $10,232.93 / $19,054.61
| Facility | | $7,413.10 | $10,232.93 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $13,182.57 / $20,892.96
| Facility | | $5,370.32 | $13,182.57 | $20,892.96 |