- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,050.30 / $15,531.30 / $31,563.60
| Facility | | $12,050.30 | $15,531.30 | $31,563.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,080.09 / $9,080.09 / $9,080.09
| Facility | | $9,080.09 | $9,080.09 | $9,080.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,595.40 / $15,788.60 / $18,050.45
| Facility | | $12,595.40 | $15,788.60 | $18,050.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,618.75 / $17,026.20 / $22,143.31
| Facility | | $9,618.75 | $17,026.20 | $22,143.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,442.10 / $10,442.10 / $10,442.10
| Facility | | $10,442.10 | $10,442.10 | $10,442.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.00 / $13,654.59 / $21,028.41
| Facility | | $1,286.00 | $13,654.59 | $21,028.41 |