- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,397.40 / $15,162.90 / $24,614.10
| Facility | | $10,397.40 | $15,162.90 | $24,614.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,814.41 / $31,012.44 / $39,759.54
| Facility | | $21,814.41 | $31,012.44 | $39,759.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,208.99 / $23,604.94 / $29,855.98
| Facility | | $12,208.99 | $23,604.94 | $29,855.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,848.00 / $16,306.60 / $26,074.90
| Facility | | $10,848.00 | $16,306.60 | $26,074.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,686.56 / $21,694.18 / $32,959.76
| Facility | | $12,686.56 | $21,694.18 | $32,959.76 |