- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,891.60 / $17,076.70 / $29,877.70
| Facility | | $12,891.60 | $17,076.70 | $29,877.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,477.00 / $11,477.00 / $11,477.00
| Facility | | $11,477.00 | $11,477.00 | $11,477.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,939.30 / $13,321.41 / $27,233.48
| Facility | | $5,939.30 | $13,321.41 | $27,233.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,276.03 / $17,307.00 / $26,675.55
| Facility | | $11,276.03 | $17,307.00 | $26,675.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $17,598.32 / $26,046.80
| Facility | | $3,496.00 | $17,598.32 | $26,046.80 |