- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,436.40 / $18,160.80 / $23,869.60
| Facility | | $12,436.40 | $18,160.80 | $23,869.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,639.84 / $12,636.04 / $21,372.16
| Facility | | $4,639.84 | $12,636.04 | $21,372.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,633.66 / $18,241.53 / $30,532.20
| Facility | | $12,633.66 | $18,241.53 | $30,532.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,643.28 / $20,357.79 / $29,724.03
| Facility | | $15,643.28 | $20,357.79 | $29,724.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,643.28 / $18,925.28 / $29,724.03
| Facility | | $15,643.28 | $18,925.28 | $29,724.03 |