- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,088.70 / $22,095.90 / $38,882.50
| Facility | | $13,088.70 | $22,095.90 | $38,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,129.58 / $14,865.76 / $24,520.80
| Facility | | $10,129.58 | $14,865.76 | $24,520.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,906.25 / $20,129.64 / $28,123.27
| Facility | | $11,906.25 | $20,129.64 | $28,123.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41,875.30 / $41,875.30 / $49,144.22
| Facility | | $41,875.30 | $41,875.30 | $49,144.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,158.00 / $18,750.55 / $31,151.72
| Facility | | $3,158.00 | $18,750.55 | $31,151.72 |