- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,925.40 / $15,472.60 / $15,472.60
| Facility | | $13,925.40 | $15,472.60 | $15,472.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,643.21 / $13,643.21 / $13,643.21
| Facility | | $13,643.21 | $13,643.21 | $13,643.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,290.50 / $8,628.51 / $21,271.25
| Facility | | $5,290.50 | $8,628.51 | $21,271.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,235.17 / $17,150.00 / $26,773.03
| Facility | | $12,235.17 | $17,150.00 | $26,773.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $23,115.71 / $29,846.25
| Facility | | $6,965.00 | $23,115.71 | $29,846.25 |