- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,505.00 / $25,737.50 / $32,795.19
| Facility | | $16,505.00 | $25,737.50 | $32,795.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46,605.41 / $46,605.41 / $46,605.41
| Facility | | $46,605.41 | $46,605.41 | $46,605.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,175.52 / $26,364.80 / $31,054.32
| Facility | | $14,175.52 | $26,364.80 | $31,054.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,048.16 / $26,738.08 / $37,458.10
| Facility | | $14,048.16 | $26,738.08 | $37,458.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,408.08 / $29,167.53 / $37,458.10
| Facility | | $25,408.08 | $29,167.53 | $37,458.10 |