- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,634.10 / $12,893.10 / $14,864.90
| Facility | | $10,634.10 | $12,893.10 | $14,864.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,774.55 / $15,601.55 / $32,331.71
| Facility | | $12,774.55 | $15,601.55 | $32,331.71 |
- 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
- $9,459.79 / $15,057.39 / $25,843.20
| Facility | | $9,459.79 | $15,057.39 | $25,843.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,137.00 / $14,668.40 / $22,754.08
| Facility | | $3,137.00 | $14,668.40 | $22,754.08 |