- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,611.00 / $28,595.60 / $40,488.30
| Facility | | $15,611.00 | $28,595.60 | $40,488.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,115.68 / $25,833.44 / $40,652.98
| Facility | | $16,115.68 | $25,833.44 | $40,652.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,230.72 / $25,723.23 / $45,765.71
| Facility | | $16,230.72 | $25,723.23 | $45,765.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,117.00 / $23,741.12 / $54,118.04
| Facility | | $7,117.00 | $23,741.12 | $54,118.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $23,741.12 / $48,092.12
| Facility | | $3,308.00 | $23,741.12 | $48,092.12 |