- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,961.00 / $29,743.20 / $47,614.40
| Facility | | $19,961.00 | $29,743.20 | $47,614.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,744.24 / $29,744.24 / $29,744.24
| Facility | | $29,744.24 | $29,744.24 | $29,744.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,054.89 / $23,450.75 / $33,279.28
| Facility | | $12,054.89 | $23,450.75 | $33,279.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,710.68 / $23,727.09 / $41,573.01
| Facility | | $17,710.68 | $23,727.09 | $41,573.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,390.45 / $26,871.16 / $36,008.16
| Facility | | $17,390.45 | $26,871.16 | $36,008.16 |