- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,319.00 / $12,680.40 / $14,005.40
| Facility | | $6,319.00 | $12,680.40 | $14,005.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,331.24 / $16,417.58 / $24,103.06
| Facility | | $14,331.24 | $16,417.58 | $24,103.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.00 / $3,067.00 / $4,334.00
| Facility | | $1,252.00 | $3,067.00 | $4,334.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,464.19 / $15,405.78 / $25,416.96
| Facility | | $9,464.19 | $15,405.78 | $25,416.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $5,505.00 / $22,013.06
| Facility | | $2,332.00 | $5,505.00 | $22,013.06 |