- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,983.40 / $18,959.59 / $24,919.40
| Facility | | $12,983.40 | $18,959.59 | $24,919.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,133.28 / $13,979.87 / $23,645.06
| Facility | | $5,133.28 | $13,979.87 | $23,645.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,189.32 / $19,043.83 / $31,875.08
| Facility | | $13,189.32 | $19,043.83 | $31,875.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,331.31 / $21,253.17 / $31,031.36
| Facility | | $16,331.31 | $21,253.17 | $31,031.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,331.31 / $19,757.66 / $31,031.36
| Facility | | $16,331.31 | $19,757.66 | $31,031.36 |