- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,839.00 / $9,504.18 / $10,957.80
| Facility | | $7,839.00 | $9,504.18 | $10,957.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,223.20 / $10,223.20 / $10,223.20
| Facility | | $10,223.20 | $10,223.20 | $10,223.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.00 / $3,715.00 / $8,731.00
| Facility | | $1,252.00 | $3,715.00 | $8,731.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,973.34 / $11,099.63 / $19,050.43
| Facility | | $6,973.34 | $11,099.63 | $19,050.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,137.00 / $10,801.46 / $16,773.29
| Facility | | $3,137.00 | $10,801.46 | $16,773.29 |