- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,016.40 / $17,796.00 / $17,796.00
| Facility | | $16,016.40 | $17,796.00 | $17,796.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,415.75 / $15,415.75 / $18,423.47
| Facility | | $15,415.75 | $15,415.75 | $18,423.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,386.86 / $12,105.54 / $30,130.42
| Facility | | $7,386.86 | $12,105.54 | $30,130.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,364.00 / $20,079.00 / $30,793.36
| Facility | | $14,364.00 | $20,079.00 | $30,793.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $26,586.84 / $34,328.06
| Facility | | $6,965.00 | $26,586.84 | $34,328.06 |