- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,099.10 / $20,491.59 / $27,484.10
| Facility | | $12,099.10 | $20,491.59 | $27,484.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,674.61 / $22,674.61 / $22,674.61
| Facility | | $22,674.61 | $22,674.61 | $22,674.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,367.19 / $22,095.06 / $26,025.12
| Facility | | $12,367.19 | $22,095.06 | $26,025.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,773.08 / $22,407.89 / $31,391.82
| Facility | | $11,773.08 | $22,407.89 | $31,391.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,293.28 / $24,443.90 / $31,391.82
| Facility | | $21,293.28 | $24,443.90 | $31,391.82 |