- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,873.50 / $18,799.20 / $24,708.60
| Facility | | $12,873.50 | $18,799.20 | $24,708.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,440.04 / $14,815.29 / $25,058.06
| Facility | | $5,440.04 | $14,815.29 | $25,058.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,077.74 / $18,882.72 / $31,605.41
| Facility | | $13,077.74 | $18,882.72 | $31,605.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,193.15 / $21,073.37 / $30,768.84
| Facility | | $16,193.15 | $21,073.37 | $30,768.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,193.15 / $19,590.50 / $30,768.84
| Facility | | $16,193.15 | $19,590.50 | $30,768.84 |