- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,793.40 / $24,523.30 / $32,232.10
| Facility | | $16,793.40 | $24,523.30 | $32,232.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,691.22 / $13,691.22 / $13,691.22
| Facility | | $13,691.22 | $13,691.22 | $13,691.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,243.10 / $25,172.44 / $42,575.80
| Facility | | $9,243.10 | $25,172.44 | $42,575.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,675.82 / $24,745.85 / $44,139.60
| Facility | | $17,675.82 | $24,745.85 | $44,139.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,123.80 / $27,490.00 / $40,137.64
| Facility | | $21,123.80 | $27,490.00 | $40,137.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,123.80 / $25,555.62 / $40,137.64
| Facility | | $21,123.80 | $25,555.62 | $40,137.64 |