- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,876.80 / $23,426.30 / $41,223.60
| Facility | | $13,876.80 | $23,426.30 | $41,223.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,113.61 / $25,055.06 / $41,427.14
| Facility | | $17,113.61 | $25,055.06 | $41,427.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,623.12 / $21,235.35 / $29,619.15
| Facility | | $12,623.12 | $21,235.35 | $29,619.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44,056.25 / $44,056.25 / $51,703.75
| Facility | | $44,056.25 | $44,056.25 | $51,703.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,158.00 / $21,528.38 / $34,599.94
| Facility | | $3,158.00 | $21,528.38 | $34,599.94 |