- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,142.70 / $16,825.20 / $16,825.20
| Facility | | $15,142.70 | $16,825.20 | $16,825.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,705.34 / $11,705.34 / $31,351.97
| Facility | | $11,705.34 | $11,705.34 | $31,351.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,153.21 / $11,968.59 / $32,778.43
| Facility | | $7,153.21 | $11,968.59 | $32,778.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,908.04 / $19,716.25 / $29,113.45
| Facility | | $13,908.04 | $19,716.25 | $29,113.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $25,136.41 / $32,455.32
| Facility | | $6,965.00 | $25,136.41 | $32,455.32 |