- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,125.00 / $16,245.70 / $21,352.50
| Facility | | $11,125.00 | $16,245.70 | $21,352.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,964.71 / $16,964.71 / $16,964.71
| Facility | | $16,964.71 | $16,964.71 | $16,964.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,082.60 / $8,496.61 / $14,199.13
| Facility | | $3,082.60 | $8,496.61 | $14,199.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,709.53 / $16,393.14 / $29,240.74
| Facility | | $11,709.53 | $16,393.14 | $29,240.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,993.68 / $18,211.04 / $26,589.60
| Facility | | $13,993.68 | $18,211.04 | $26,589.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,993.68 / $16,929.59 / $26,589.60
| Facility | | $13,993.68 | $16,929.59 | $26,589.60 |