- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,899.40 / $18,957.50 / $29,268.80
| Facility | | $12,899.40 | $18,957.50 | $29,268.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,699.92 / $36,536.28 / $46,841.38
| Facility | | $25,699.92 | $36,536.28 | $46,841.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,517.77 / $28,068.75 / $35,501.89
| Facility | | $14,517.77 | $28,068.75 | $35,501.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,899.40 / $19,390.20 / $31,005.80
| Facility | | $12,899.40 | $19,390.20 | $31,005.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,085.65 / $25,796.65 / $39,192.61
| Facility | | $15,085.65 | $25,796.65 | $39,192.61 |