- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,272.00 / $15,857.80 / $15,857.80
| Facility | | $14,272.00 | $15,857.80 | $15,857.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,814.45 / $14,814.45 / $14,814.45
| Facility | | $14,814.45 | $14,814.45 | $14,814.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,813.71 / $10,497.79 / $20,601.64
| Facility | | $6,813.71 | $10,497.79 | $20,601.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,108.40 / $17,902.13 / $27,439.57
| Facility | | $13,108.40 | $17,902.13 | $27,439.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $23,691.19 / $30,589.30
| Facility | | $6,965.00 | $23,691.19 | $30,589.30 |