- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,763.00 / $16,403.40 / $16,403.40
| Facility | | $14,763.00 | $16,403.40 | $16,403.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,234.62 / $25,234.62 / $25,234.62
| Facility | | $25,234.62 | $25,234.62 | $25,234.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,395.75 / $11,264.85 / $20,308.34
| Facility | | $6,395.75 | $11,264.85 | $20,308.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,559.37 / $18,508.00 / $28,383.58
| Facility | | $13,559.37 | $18,508.00 | $28,383.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $24,506.24 / $31,641.66
| Facility | | $6,965.00 | $24,506.24 | $31,641.66 |