- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,093.40 / $20,103.80 / $20,103.80
| Facility | | $18,093.40 | $20,103.80 | $20,103.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,090.45 / $9,090.45 / $23,465.23
| Facility | | $9,090.45 | $9,090.45 | $23,465.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,910.27 / $17,503.97 / $39,496.94
| Facility | | $10,910.27 | $17,503.97 | $39,496.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,805.00 / $22,134.90 / $34,786.54
| Facility | | $14,805.00 | $22,134.90 | $34,786.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $30,034.54 / $38,779.61
| Facility | | $6,965.00 | $30,034.54 | $38,779.61 |