- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,297.54 / $12,829.10 / $21,471.40
| Facility | | $9,297.54 | $12,829.10 | $21,471.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,272.00 / $12,714.47 / $19,697.11
| Facility | | $3,272.00 | $12,714.47 | $19,697.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.60 / $240.60 / $240.60
| Facility | | $240.60 | $240.60 | $240.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,515.95 / $14,433.32 / $24,204.60
| Facility | | $9,515.95 | $14,433.32 | $24,204.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $14,718.15 / $25,901.77
| Facility | | $4,062.00 | $14,718.15 | $25,901.77 |