- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,427.40 / $12,642.50 / $14,576.00
| Facility | | $10,427.40 | $12,642.50 | $14,576.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,499.10 / $10,499.10 / $10,499.10
| Facility | | $10,499.10 | $10,499.10 | $10,499.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.00 / $2,554.00 / $3,843.00
| Facility | | $1,252.00 | $2,554.00 | $3,843.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,275.94 / $14,764.74 / $25,340.91
| Facility | | $9,275.94 | $14,764.74 | $25,340.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $5,310.00 / $21,947.19
| Facility | | $2,332.00 | $5,310.00 | $21,947.19 |