- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,701.20 / $17,196.59 / $26,953.90
| Facility | | $11,701.20 | $17,196.59 | $26,953.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,621.39 / $32,159.68 / $41,230.36
| Facility | | $22,621.39 | $32,159.68 | $41,230.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,169.28 / $25,680.56 / $37,303.62
| Facility | | $13,169.28 | $25,680.56 | $37,303.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,701.20 / $17,589.20 / $28,125.90
| Facility | | $11,701.20 | $17,589.20 | $28,125.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,684.41 / $23,400.51 / $35,552.18
| Facility | | $13,684.41 | $23,400.51 | $35,552.18 |