- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,008.20 / $12,134.20 / $13,990.00
| Facility | | $10,008.20 | $12,134.20 | $13,990.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,711.44 / $15,711.44 / $15,711.44
| Facility | | $15,711.44 | $15,711.44 | $15,711.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.00 / $3,485.00 / $5,462.00
| Facility | | $1,252.00 | $3,485.00 | $5,462.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,903.00 / $14,171.12 / $24,322.08
| Facility | | $8,903.00 | $14,171.12 | $24,322.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,137.00 / $14,039.28 / $21,414.79
| Facility | | $3,137.00 | $14,039.28 | $21,414.79 |