- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,088.80 / $17,629.50 / $28,618.20
| Facility | | $12,088.80 | $17,629.50 | $28,618.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,628.68 / $37,856.64 / $48,534.16
| Facility | | $26,628.68 | $37,856.64 | $48,534.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,195.09 / $27,444.88 / $34,712.81
| Facility | | $14,195.09 | $27,444.88 | $34,712.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,612.60 / $18,959.30 / $30,316.70
| Facility | | $12,612.60 | $18,959.30 | $30,316.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,556.91 / $25,223.28 / $38,321.50
| Facility | | $15,556.91 | $25,223.28 | $38,321.50 |