- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,975.00 / $21,083.30 / $21,083.30
| Facility | | $18,975.00 | $21,083.30 | $21,083.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,301.06 / $16,301.06 / $26,461.66
| Facility | | $16,301.06 | $16,301.06 | $26,461.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,213.21 / $15,586.82 / $39,729.75
| Facility | | $10,213.21 | $15,586.82 | $39,729.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,427.91 / $24,706.08 / $36,481.54
| Facility | | $17,427.91 | $24,706.08 | $36,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $31,497.98 / $40,669.17
| Facility | | $6,965.00 | $31,497.98 | $40,669.17 |