- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,648.10 / $13,817.60 / $28,913.50
| Facility | | $13,648.10 | $13,817.60 | $28,913.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,249.91 / $25,099.90 / $33,678.65
| Facility | | $18,249.91 | $25,099.90 | $33,678.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,952.61 / $20,533.91 / $28,785.17
| Facility | | $14,952.61 | $20,533.91 | $28,785.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,017.60 / $22,805.21 / $28,749.91
| Facility | | $13,017.60 | $22,805.21 | $28,749.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,017.60 / $22,995.05 / $30,153.37
| Facility | | $13,017.60 | $22,995.05 | $30,153.37 |