- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,845.00 / $15,815.60 / $25,673.70
| Facility | | $10,845.00 | $15,815.60 | $25,673.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,890.10 / $38,228.28 / $49,010.62
| Facility | | $26,890.10 | $38,228.28 | $49,010.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,734.58 / $24,621.11 / $31,141.25
| Facility | | $12,734.58 | $24,621.11 | $31,141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,315.00 / $17,008.59 / $27,197.50
| Facility | | $11,315.00 | $17,008.59 | $27,197.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,232.71 / $22,628.09 / $34,378.65
| Facility | | $13,232.71 | $22,628.09 | $34,378.65 |