- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,049.30 / $15,610.30 / $15,610.30
| Facility | | $14,049.30 | $15,610.30 | $15,610.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,784.53 / $5,784.53 / $16,649.39
| Facility | | $5,784.53 | $5,784.53 | $16,649.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,980.58 / $10,654.98 / $19,397.55
| Facility | | $5,980.58 | $10,654.98 | $19,397.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,903.80 / $18,292.63 / $27,011.30
| Facility | | $12,903.80 | $18,292.63 | $27,011.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $23,321.42 / $30,111.86
| Facility | | $6,965.00 | $23,321.42 | $30,111.86 |