- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,094.40 / $14,721.00 / $23,896.80
| Facility | | $10,094.40 | $14,721.00 | $23,896.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,229.88 / $30,181.44 / $38,694.16
| Facility | | $21,229.88 | $30,181.44 | $38,694.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,853.20 / $22,917.05 / $28,985.92
| Facility | | $11,853.20 | $22,917.05 | $28,985.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,531.80 / $15,831.40 / $25,315.10
| Facility | | $10,531.80 | $15,831.40 | $25,315.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,316.85 / $21,061.97 / $31,999.25
| Facility | | $12,316.85 | $21,061.97 | $31,999.25 |