- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,455.80 / $16,836.00 / $25,993.30
| Facility | | $11,455.80 | $16,836.00 | $25,993.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,010.05 / $36,977.17 / $47,406.63
| Facility | | $26,010.05 | $36,977.17 | $47,406.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,893.10 / $24,927.60 / $31,528.91
| Facility | | $12,893.10 | $24,927.60 | $31,528.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,455.80 / $17,220.30 / $27,536.00
| Facility | | $11,455.80 | $17,220.30 | $27,536.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,397.43 / $22,909.77 / $34,806.60
| Facility | | $13,397.43 | $22,909.77 | $34,806.60 |