- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,207.20 / $26,885.00 / $36,077.50
| Facility | | $16,207.20 | $26,885.00 | $36,077.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,204.22 / $27,204.22 / $27,204.22
| Facility | | $27,204.22 | $27,204.22 | $27,204.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,895.05 / $22,471.66 / $35,955.53
| Facility | | $11,895.05 | $22,471.66 | $35,955.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,308.27 / $21,646.50 / $49,644.08
| Facility | | $13,308.27 | $21,646.50 | $49,644.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,757.80 / $21,323.25 / $30,206.97
| Facility | | $15,757.80 | $21,323.25 | $30,206.97 |