- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,047.70 / $15,608.60 / $15,608.60
| Facility | | $14,047.70 | $15,608.60 | $15,608.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,141.00 / $14,141.00 / $21,153.50
| Facility | | $14,141.00 | $14,141.00 | $21,153.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,868.72 / $10,878.00 / $18,950.40
| Facility | | $5,868.72 | $10,878.00 | $18,950.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,902.36 / $17,620.75 / $27,008.28
| Facility | | $12,902.36 | $17,620.75 | $27,008.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $23,318.82 / $30,108.50
| Facility | | $6,965.00 | $23,318.82 | $30,108.50 |