- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,961.40 / $29,795.00 / $39,982.50
| Facility | | $17,961.40 | $29,795.00 | $39,982.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,904.11 / $20,904.11 / $20,904.11
| Facility | | $20,904.11 | $20,904.11 | $20,904.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,763.24 / $25,714.36 / $39,760.56
| Facility | | $14,763.24 | $25,714.36 | $39,760.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,748.74 / $23,989.50 / $55,017.52
| Facility | | $14,748.74 | $23,989.50 | $55,017.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,510.74 / $23,631.26 / $33,476.55
| Facility | | $17,510.74 | $23,631.26 | $33,476.55 |