- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,517.60 / $13,964.20 / $16,099.90
| Facility | | $11,517.60 | $13,964.20 | $16,099.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,636.24 / $17,636.24 / $17,636.24
| Facility | | $17,636.24 | $17,636.24 | $17,636.24 |
- 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
- $10,245.70 / $16,308.33 / $27,990.19
| Facility | | $10,245.70 | $16,308.33 | $27,990.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $5,310.00 / $24,241.68
| Facility | | $2,332.00 | $5,310.00 | $24,241.68 |