- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,315.20 / $17,016.90 / $17,016.90
| Facility | | $15,315.20 | $17,016.90 | $17,016.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,553.92 / $14,141.00 / $31,568.03
| Facility | | $12,553.92 | $14,141.00 | $31,568.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,901.25 / $13,074.28 / $29,168.48
| Facility | | $7,901.25 | $13,074.28 | $29,168.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,620.19 / $18,736.16 / $29,445.21
| Facility | | $10,620.19 | $18,736.16 | $29,445.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $25,422.85 / $32,825.16
| Facility | | $6,965.00 | $25,422.85 | $32,825.16 |