- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,794.00 / $32,603.00 / $64,822.50
| Facility | | $8,794.00 | $32,603.00 | $64,822.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,231.00 / $35,049.61 / $44,904.94
| Facility | | $11,231.00 | $35,049.61 | $44,904.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,362.04 / $31,640.00 / $51,507.15
| Facility | | $20,362.04 | $31,640.00 | $51,507.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,935.68 / $30,165.02 / $55,343.53
| Facility | | $16,935.68 | $30,165.02 | $55,343.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,414.44 / $36,796.00 / $50,179.02
| Facility | | $24,414.44 | $36,796.00 | $50,179.02 |