- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,537.50 / $25,041.70 / $25,041.70
| Facility | | $22,537.50 | $25,041.70 | $25,041.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,141.00 / $21,453.25 / $30,509.50
| Facility | | $14,141.00 | $21,453.25 | $30,509.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,586.49 / $13,360.13 / $25,813.07
| Facility | | $6,586.49 | $13,360.13 | $25,813.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,138.00 / $27,571.71 / $43,330.87
| Facility | | $10,138.00 | $27,571.71 | $43,330.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,020.13 / $36,578.37 / $58,758.16
| Facility | | $12,020.13 | $36,578.37 | $58,758.16 |