- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,159.10 / $15,732.30 / $15,732.30
| Facility | | $14,159.10 | $15,732.30 | $15,732.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,690.36 / $13,647.74 / $18,796.68
| Facility | | $7,690.36 | $13,647.74 | $18,796.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,547.19 / $9,874.35 / $18,555.68
| Facility | | $5,547.19 | $9,874.35 | $18,555.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,434.00 / $17,321.80 / $27,222.42
| Facility | | $10,434.00 | $17,321.80 | $27,222.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $23,503.70 / $30,347.22
| Facility | | $6,965.00 | $23,503.70 | $30,347.22 |