- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,526.80 / $15,470.70 / $23,885.40
| Facility | | $10,526.80 | $15,470.70 | $23,885.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,997.69 / $29,851.35 / $38,270.96
| Facility | | $20,997.69 | $29,851.35 | $38,270.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,847.56 / $22,906.15 / $28,972.14
| Facility | | $11,847.56 | $22,906.15 | $28,972.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,526.80 / $15,823.90 / $25,303.00
| Facility | | $10,526.80 | $15,823.90 | $25,303.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,854.70 / $21,051.95 / $31,984.03
| Facility | | $13,854.70 | $21,051.95 | $31,984.03 |