- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,635.00 / $27,271.70 / $47,817.70
| Facility | | $16,635.00 | $27,271.70 | $47,817.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,520.28 / $29,520.28 / $29,520.28
| Facility | | $29,520.28 | $29,520.28 | $29,520.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,030.92 / $24,704.82 / $33,213.11
| Facility | | $12,030.92 | $24,704.82 | $33,213.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,786.27 / $23,828.36 / $41,750.46
| Facility | | $17,786.27 | $23,828.36 | $41,750.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,694.00 / $31,337.72 / $36,953.87
| Facility | | $16,694.00 | $31,337.72 | $36,953.87 |