- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,111.30 / $16,790.30 / $16,790.30
| Facility | | $15,111.30 | $16,790.30 | $16,790.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,174.07 / $12,336.40 / $15,142.88
| Facility | | $11,174.07 | $12,336.40 | $15,142.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,898.70 / $12,314.09 / $31,749.48
| Facility | | $7,898.70 | $12,314.09 | $31,749.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,879.23 / $18,954.84 / $29,053.13
| Facility | | $13,879.23 | $18,954.84 | $29,053.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $25,084.33 / $32,388.07
| Facility | | $6,965.00 | $25,084.33 | $32,388.07 |