- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,445.30 / $14,939.30 / $14,939.30
| Facility | | $13,445.30 | $14,939.30 | $14,939.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,040.00 / $10,962.94 / $14,141.00
| Facility | | $5,040.00 | $10,962.94 | $14,141.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,426.25 / $9,357.17 / $16,800.28
| Facility | | $5,426.25 | $9,357.17 | $16,800.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,323.53 / $16,448.61 / $25,850.14
| Facility | | $9,323.53 | $16,448.61 | $25,850.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $22,318.88 / $28,817.42
| Facility | | $6,965.00 | $22,318.88 | $28,817.42 |