- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,117.50 / $14,575.00 / $14,575.00
| Facility | | $13,117.50 | $14,575.00 | $14,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,762.02 / $12,762.02 / $12,762.02
| Facility | | $12,762.02 | $12,762.02 | $12,762.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,751.36 / $12,107.36 / $28,957.57
| Facility | | $7,751.36 | $12,107.36 | $28,957.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,047.97 / $16,445.00 / $25,219.79
| Facility | | $12,047.97 | $16,445.00 | $25,219.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.00 / $21,774.65 / $28,114.72
| Facility | | $6,965.00 | $21,774.65 | $28,114.72 |