- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,560.60 / $14,016.40 / $16,160.00
| Facility | | $11,560.60 | $14,016.40 | $16,160.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,190.80 / $17,190.80 / $17,190.80
| Facility | | $17,190.80 | $17,190.80 | $17,190.80 |
- 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
- $10,283.98 / $16,369.26 / $28,094.77
| Facility | | $10,283.98 | $16,369.26 | $28,094.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $5,310.00 / $24,332.25
| Facility | | $2,332.00 | $5,310.00 | $24,332.25 |