- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,996.90 / $18,885.40 / $18,885.40
| Facility | | $16,996.90 | $18,885.40 | $18,885.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,116.08 / $20,116.08 / $20,116.08
| Facility | | $20,116.08 | $20,116.08 | $20,116.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,564.40 / $11,734.57 / $25,744.71
| Facility | | $7,564.40 | $11,734.57 | $25,744.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,805.00 / $20,793.45 / $32,678.36
| Facility | | $14,805.00 | $20,793.45 | $32,678.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $23,952.93 / $36,429.44
| Facility | | $6,965.00 | $23,952.93 | $36,429.44 |