- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,068.40 / $29,135.00 / $47,356.70
| Facility | | $17,068.40 | $29,135.00 | $47,356.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,258.00 / $11,258.00 / $11,258.00
| Facility | | $11,258.00 | $11,258.00 | $11,258.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,636.01 / $23,149.22 / $36,520.14
| Facility | | $14,636.01 | $23,149.22 | $36,520.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,130.67 / $27,299.45 / $59,823.89
| Facility | | $14,130.67 | $27,299.45 | $59,823.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,062.77 / $26,343.43 / $35,069.12
| Facility | | $17,062.77 | $26,343.43 | $35,069.12 |