- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,937.50 / $19,013.59 / $29,355.40
| Facility | | $12,937.50 | $19,013.59 | $29,355.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,256.65 / $35,906.11 / $46,033.47
| Facility | | $25,256.65 | $35,906.11 | $46,033.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,560.75 / $28,151.84 / $35,606.99
| Facility | | $14,560.75 | $28,151.84 | $35,606.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,937.50 / $19,447.59 / $31,097.60
| Facility | | $12,937.50 | $19,447.59 | $31,097.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,130.31 / $25,873.02 / $39,308.62
| Facility | | $15,130.31 | $25,873.02 | $39,308.62 |