- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,716.30 / $12,992.70 / $14,979.80
| Facility | | $10,716.30 | $12,992.70 | $14,979.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,890.67 / $21,890.67 / $23,658.66
| Facility | | $21,890.67 | $21,890.67 | $23,658.66 |
- 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
- $9,532.87 / $15,173.72 / $26,042.84
| Facility | | $9,532.87 | $15,173.72 | $26,042.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,137.00 / $15,116.62 / $22,929.86
| Facility | | $3,137.00 | $15,116.62 | $22,929.86 |