- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,098.00 / $27,096.60 / $44,986.80
| Facility | | $17,098.00 | $27,096.60 | $44,986.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,341.60 / $31,341.60 / $31,341.60
| Facility | | $31,341.60 | $31,341.60 | $31,341.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,416.00 / $26,090.21 / $44,197.36
| Facility | | $17,416.00 | $26,090.21 | $44,197.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,356.45 / $29,619.53 / $51,730.79
| Facility | | $23,356.45 | $29,619.53 | $51,730.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,964.15 / $29,015.52 / $77,877.50
| Facility | | $13,964.15 | $29,015.52 | $77,877.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,964.15 / $27,702.97 / $38,935.16
| Facility | | $13,964.15 | $27,702.97 | $38,935.16 |