- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,318.30 / $14,798.10 / $14,798.10
| Facility | | $13,318.30 | $14,798.10 | $14,798.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,830.83 / $10,830.83 / $10,830.83
| Facility | | $10,830.83 | $10,830.83 | $10,830.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,381.95 / $10,531.16 / $24,505.60
| Facility | | $6,381.95 | $10,531.16 | $24,505.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,232.39 / $16,705.77 / $25,605.84
| Facility | | $12,232.39 | $16,705.77 | $25,605.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $18,768.84 / $28,545.08
| Facility | | $6,965.00 | $18,768.84 | $28,545.08 |