- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,425.00 / $15,203.10 / $24,679.40
| Facility | | $10,425.00 | $15,203.10 | $24,679.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,076.62 / $37,071.81 / $47,527.96
| Facility | | $26,076.62 | $37,071.81 | $47,527.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,241.40 / $23,667.60 / $29,935.23
| Facility | | $12,241.40 | $23,667.60 | $29,935.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,876.80 / $16,349.90 / $26,144.20
| Facility | | $10,876.80 | $16,349.90 | $26,144.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,720.24 / $21,751.76 / $33,047.25
| Facility | | $12,720.24 | $21,751.76 | $33,047.25 |