- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,487.40 / $18,352.20 / $28,334.10
| Facility | | $12,487.40 | $18,352.20 | $28,334.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,623.21 / $33,583.92 / $43,056.31
| Facility | | $23,623.21 | $33,583.92 | $43,056.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,107.83 / $26,529.26 / $42,559.57
| Facility | | $13,107.83 | $26,529.26 | $42,559.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,487.40 / $18,771.09 / $30,015.80
| Facility | | $12,487.40 | $18,771.09 | $30,015.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,603.93 / $24,972.90 / $37,941.10
| Facility | | $14,603.93 | $24,972.90 | $37,941.10 |