- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,275.20 / $15,100.90 / $23,314.40
| Facility | | $10,275.20 | $15,100.90 | $23,314.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,671.13 / $27,965.44 / $35,853.12
| Facility | | $19,671.13 | $27,965.44 | $35,853.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,564.34 / $22,358.56 / $28,279.53
| Facility | | $11,564.34 | $22,358.56 | $28,279.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,275.20 / $15,445.60 / $24,698.10
| Facility | | $10,275.20 | $15,445.60 | $24,698.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,801.66 / $20,548.68 / $31,219.43
| Facility | | $12,801.66 | $20,548.68 | $31,219.43 |