- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,654.10 / $17,393.40 / $17,393.40
| Facility | | $15,654.10 | $17,393.40 | $17,393.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,475.97 / $14,475.97 / $15,313.68
| Facility | | $14,475.97 | $14,475.97 | $15,313.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,774.79 / $11,402.50 / $26,622.56
| Facility | | $6,774.79 | $11,402.50 | $26,622.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,089.41 / $19,150.70 / $30,096.66
| Facility | | $11,089.41 | $19,150.70 | $30,096.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,903.00 / $25,985.32 / $40,812.11
| Facility | | $12,903.00 | $25,985.32 | $40,812.11 |