- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,786.70 / $13,078.00 / $15,078.20
| Facility | | $10,786.70 | $13,078.00 | $15,078.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,797.50 / $16,797.50 / $16,797.50
| Facility | | $16,797.50 | $16,797.50 | $16,797.50 |
- 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
- $9,595.52 / $15,273.42 / $26,213.97
| Facility | | $9,595.52 | $15,273.42 | $26,213.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $5,310.00 / $22,703.33
| Facility | | $2,332.00 | $5,310.00 | $22,703.33 |