- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,100.40 / $27,950.40 / $48,902.60
| Facility | | $21,100.40 | $27,950.40 | $48,902.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,330.00 / $23,425.34 / $39,186.87
| Facility | | $10,330.00 | $23,425.34 | $39,186.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,939.30 / $24,572.97 / $47,988.88
| Facility | | $5,939.30 | $24,572.97 | $47,988.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,912.18 / $26,816.08 / $43,661.48
| Facility | | $15,912.18 | $26,816.08 | $43,661.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $28,804.22 / $43,994.89
| Facility | | $3,496.00 | $28,804.22 | $43,994.89 |