- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,053.40 / $27,598.00 / $35,404.40
| Facility | | $12,053.40 | $27,598.00 | $35,404.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,943.61 / $10,249.44 / $16,946.88
| Facility | | $6,943.61 | $10,249.44 | $16,946.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,841.21 / $18,489.20 / $25,607.58
| Facility | | $10,841.21 | $18,489.20 | $25,607.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36,400.40 / $36,400.40 / $42,718.96
| Facility | | $36,400.40 | $36,400.40 | $42,718.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,520.00 / $16,395.87 / $24,911.11
| Facility | | $2,520.00 | $16,395.87 | $24,911.11 |