- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,636.70 / $17,101.90 / $26,403.80
| Facility | | $11,636.70 | $17,101.90 | $26,403.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,484.80 / $30,543.85 / $39,158.78
| Facility | | $21,484.80 | $30,543.85 | $39,158.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,096.71 / $25,321.27 / $32,026.82
| Facility | | $13,096.71 | $25,321.27 | $32,026.82 |
- 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 |