- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,696.20 / $14,180.80 / $16,349.60
| Facility | | $11,696.20 | $14,180.80 | $16,349.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,093.87 / $16,093.87 / $16,093.87
| Facility | | $16,093.87 | $16,093.87 | $16,093.87 |
- 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
- $10,404.62 / $16,561.28 / $28,424.35
| Facility | | $10,404.62 | $16,561.28 | $28,424.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,137.00 / $16,530.79 / $30,881.99
| Facility | | $3,137.00 | $16,530.79 | $30,881.99 |