- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,678.30 / $16,309.30 / $16,309.30
| Facility | | $14,678.30 | $16,309.30 | $16,309.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,942.67 / $16,181.88 / $21,440.40
| Facility | | $14,942.67 | $16,181.88 | $21,440.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,929.34 / $12,527.00 / $25,827.97
| Facility | | $7,929.34 | $12,527.00 | $25,827.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,545.00 / $17,957.02 / $28,220.71
| Facility | | $12,545.00 | $17,957.02 | $28,220.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $24,365.63 / $31,460.11
| Facility | | $6,965.00 | $24,365.63 | $31,460.11 |