- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,678.20 / $22,994.60 / $40,463.90
| Facility | | $11,678.20 | $22,994.60 | $40,463.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,053.62 / $38,550.06 / $63,155.60
| Facility | | $26,053.62 | $38,550.06 | $63,155.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,390.50 / $20,875.50 / $29,163.36
| Facility | | $12,390.50 | $20,875.50 | $29,163.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,124.28 / $48,537.00 / $48,537.00
| Facility | | $19,124.28 | $48,537.00 | $48,537.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,520.00 / $21,865.11 / $35,296.00
| Facility | | $2,520.00 | $21,865.11 | $35,296.00 |