- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,703.20 / $30,781.40 / $30,781.40
| Facility | | $27,703.20 | $30,781.40 | $30,781.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,036.05 / $27,036.05 / $27,527.85
| Facility | | $27,036.05 | $27,036.05 | $27,527.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,013.19 / $21,080.32 / $42,126.96
| Facility | | $12,013.19 | $21,080.32 | $42,126.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,489.00 / $33,891.31 / $53,262.56
| Facility | | $21,489.00 | $33,891.31 | $53,262.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,259.69 / $44,962.36 / $72,225.87
| Facility | | $14,259.69 | $44,962.36 | $72,225.87 |