- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,097.40 / $14,725.40 / $23,903.90
| Facility | | $10,097.40 | $14,725.40 | $23,903.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,668.08 / $29,382.76 / $37,670.19
| Facility | | $20,668.08 | $29,382.76 | $37,670.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,856.72 / $22,923.86 / $28,994.53
| Facility | | $11,856.72 | $22,923.86 | $28,994.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,535.00 / $15,836.10 / $25,322.60
| Facility | | $10,535.00 | $15,836.10 | $25,322.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,320.51 / $21,068.23 / $32,008.76
| Facility | | $12,320.51 | $21,068.23 | $32,008.76 |