- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,982.40 / $25,292.80 / $44,508.10
| Facility | | $14,982.40 | $25,292.80 | $44,508.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,089.56 / $11,843.46 / $19,582.50
| Facility | | $8,089.56 | $11,843.46 | $19,582.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,238.04 / $22,927.28 / $31,589.76
| Facility | | $13,238.04 | $22,927.28 | $31,589.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46,507.50 / $46,507.50 / $54,580.50
| Facility | | $46,507.50 | $46,507.50 | $54,580.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,520.00 / $23,595.00 / $31,485.15
| Facility | | $2,520.00 | $23,595.00 | $31,485.15 |