- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,625.30 / $16,976.50 / $22,312.90
| Facility | | $11,625.30 | $16,976.50 | $22,312.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,251.48 / $14,301.77 / $24,189.52
| Facility | | $5,251.48 | $14,301.77 | $24,189.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,809.75 / $17,051.90 / $30,555.94
| Facility | | $11,809.75 | $17,051.90 | $30,555.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,623.10 / $19,030.14 / $27,785.56
| Facility | | $14,623.10 | $19,030.14 | $27,785.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,623.10 / $17,691.06 / $27,785.56
| Facility | | $14,623.10 | $17,691.06 | $27,785.56 |