- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,291.20 / $16,594.00 / $25,619.80
| Facility | | $11,291.20 | $16,594.00 | $25,619.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,999.88 / $45,492.61 / $58,323.86
| Facility | | $31,999.88 | $45,492.61 | $58,323.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,707.81 / $24,569.35 / $31,075.78
| Facility | | $12,707.81 | $24,569.35 | $31,075.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,291.20 / $16,972.80 / $27,140.30
| Facility | | $11,291.20 | $16,972.80 | $27,140.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,204.89 / $22,580.52 / $34,306.37
| Facility | | $13,204.89 | $22,580.52 | $34,306.37 |