- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,236.70 / $16,514.00 / $25,496.20
| Facility | | $11,236.70 | $16,514.00 | $25,496.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,121.06 / $41,399.94 / $53,076.84
| Facility | | $29,121.06 | $41,399.94 | $53,076.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,646.51 / $24,450.84 / $30,925.89
| Facility | | $12,646.51 | $24,450.84 | $30,925.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,236.70 / $16,890.90 / $27,009.40
| Facility | | $11,236.70 | $16,890.90 | $27,009.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,935.05 / $22,471.61 / $34,140.90
| Facility | | $13,935.05 | $22,471.61 | $34,140.90 |