- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,358.40 / $19,507.20 / $25,639.20
| Facility | | $13,358.40 | $19,507.20 | $25,639.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,808.79 / $29,436.41 / $49,787.71
| Facility | | $10,808.79 | $29,436.41 | $49,787.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,060.31 / $19,684.20 / $35,743.15
| Facility | | $14,060.31 | $19,684.20 | $35,743.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,803.02 / $21,867.05 / $31,927.67
| Facility | | $16,803.02 | $21,867.05 | $31,927.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,803.02 / $20,328.34 / $31,927.67
| Facility | | $16,803.02 | $20,328.34 | $31,927.67 |