- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,264.40 / $12,444.80 / $14,348.20
| Facility | | $10,264.40 | $12,444.80 | $14,348.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,123.90 / $12,123.90 / $13,631.76
| Facility | | $12,123.90 | $12,123.90 | $13,631.76 |
- 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
- $9,130.94 / $14,533.94 / $24,944.78
| Facility | | $9,130.94 | $14,533.94 | $24,944.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,137.00 / $14,204.13 / $21,963.06
| Facility | | $3,137.00 | $14,204.13 | $21,963.06 |