- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,055.10 / $21,917.30 / $27,927.40
| Facility | | $14,055.10 | $21,917.30 | $27,927.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32,161.63 / $32,161.63 / $32,161.63
| Facility | | $32,161.63 | $32,161.63 | $32,161.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,448.53 / $22,451.44 / $26,444.88
| Facility | | $11,448.53 | $22,451.44 | $26,444.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,962.97 / $22,769.31 / $31,898.13
| Facility | | $11,962.97 | $22,769.31 | $31,898.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,636.72 / $24,838.15 / $31,898.13
| Facility | | $21,636.72 | $24,838.15 | $31,898.13 |