- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,029.60 / $14,477.40 / $14,477.40
| Facility | | $13,029.60 | $14,477.40 | $14,477.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,141.00 / $14,141.00 / $14,141.00
| Facility | | $14,141.00 | $14,141.00 | $14,141.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,499.89 / $11,602.48 / $17,429.91
| Facility | | $4,499.89 | $11,602.48 | $17,429.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,579.00 / $15,940.04 / $25,050.90
| Facility | | $10,579.00 | $15,940.04 | $25,050.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,898.02 / $21,147.08 / $33,969.87
| Facility | | $7,898.02 | $21,147.08 | $33,969.87 |