- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,460.80 / $16,843.40 / $26,004.70
| Facility | | $11,460.80 | $16,843.40 | $26,004.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,296.85 / $33,119.94 / $42,461.47
| Facility | | $23,296.85 | $33,119.94 | $42,461.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,898.74 / $24,938.50 / $31,542.69
| Facility | | $12,898.74 | $24,938.50 | $31,542.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,460.80 / $17,227.80 / $27,548.00
| Facility | | $11,460.80 | $17,227.80 | $27,548.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,403.29 / $22,919.79 / $34,821.82
| Facility | | $13,403.29 | $22,919.79 | $34,821.82 |