- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,817.30 / $15,897.60 / $24,544.50
| Facility | | $10,817.30 | $15,897.60 | $24,544.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,957.33 / $25,228.70 / $29,905.12
| Facility | | $15,957.33 | $25,228.70 | $29,905.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,549.32 / $39,165.47 / $50,212.14
| Facility | | $27,549.32 | $39,165.47 | $50,212.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,174.47 / $23,538.19 / $29,771.56
| Facility | | $12,174.47 | $23,538.19 | $29,771.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,817.30 / $16,260.50 / $26,001.20
| Facility | | $10,817.30 | $16,260.50 | $26,001.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,650.69 / $21,632.83 / $32,866.56
| Facility | | $12,650.69 | $21,632.83 | $32,866.56 |