- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,682.50 / $25,062.50 / $40,737.10
| Facility | | $14,682.50 | $25,062.50 | $40,737.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,882.21 / $20,841.48 / $28,194.78
| Facility | | $13,882.21 | $20,841.48 | $28,194.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,590.18 / $19,913.40 / $31,415.31
| Facility | | $12,590.18 | $19,913.40 | $31,415.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,950.89 / $10,270.54 / $31,683.47
| Facility | | $3,950.89 | $10,270.54 | $31,683.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,289.00 / $20,633.70 / $28,608.68
| Facility | | $6,289.00 | $20,633.70 | $28,608.68 |