- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,298.50 / $13,698.60 / $15,793.70
| Facility | | $11,298.50 | $13,698.60 | $15,793.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,040.95 / $14,040.95 / $14,040.95
| Facility | | $14,040.95 | $14,040.95 | $14,040.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.00 / $3,715.00 / $14,552.00
| Facility | | $1,252.00 | $3,715.00 | $14,552.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,050.82 / $15,998.13 / $27,457.80
| Facility | | $10,050.82 | $15,998.13 | $27,457.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,137.00 / $15,968.67 / $24,175.69
| Facility | | $3,137.00 | $15,968.67 | $24,175.69 |