- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,153.40 / $16,265.40 / $26,403.80
| Facility | | $11,153.40 | $16,265.40 | $26,403.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,336.43 / $26,067.99 / $33,420.50
| Facility | | $18,336.43 | $26,067.99 | $33,420.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,096.71 / $25,539.06 / $37,098.07
| Facility | | $13,096.71 | $25,539.06 | $37,098.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,636.70 / $17,492.20 / $27,970.90
| Facility | | $11,636.70 | $17,492.20 | $27,970.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,609.01 / $23,271.57 / $35,356.28
| Facility | | $13,609.01 | $23,271.57 | $35,356.28 |