- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,292.40 / $16,595.90 / $25,622.60
| Facility | | $11,292.40 | $16,595.90 | $25,622.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,408.06 / $38,964.64 / $49,954.67
| Facility | | $27,408.06 | $38,964.64 | $49,954.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,709.22 / $24,572.08 / $31,079.23
| Facility | | $12,709.22 | $24,572.08 | $31,079.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,292.40 / $16,974.70 / $27,143.30
| Facility | | $11,292.40 | $16,974.70 | $27,143.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,206.35 / $22,583.02 / $34,310.18
| Facility | | $13,206.35 | $22,583.02 | $34,310.18 |