- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,665.80 / $15,675.00 / $24,200.80
| Facility | | $10,665.80 | $15,675.00 | $24,200.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,391.62 / $37,519.62 / $48,102.09
| Facility | | $26,391.62 | $37,519.62 | $48,102.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,003.97 / $23,208.55 / $29,354.62
| Facility | | $12,003.97 | $23,208.55 | $29,354.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,665.80 / $16,032.80 / $25,637.10
| Facility | | $10,665.80 | $16,032.80 | $25,637.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,473.52 / $21,329.87 / $32,406.28
| Facility | | $12,473.52 | $21,329.87 | $32,406.28 |