- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,533.20 / $13,983.20 / $16,121.80
| Facility | | $11,533.20 | $13,983.20 | $16,121.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,893.03 / $13,893.03 / $13,893.03
| Facility | | $13,893.03 | $13,893.03 | $13,893.03 |
- 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
- $10,259.62 / $16,330.48 / $28,028.22
| Facility | | $10,259.62 | $16,330.48 | $28,028.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,137.00 / $16,300.41 / $24,677.92
| Facility | | $3,137.00 | $16,300.41 | $24,677.92 |