- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,296.30 / $22,043.80 / $28,583.80
| Facility | | $14,296.30 | $22,043.80 | $28,583.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,631.68 / $21,829.31 / $29,699.14
| Facility | | $12,631.68 | $21,829.31 | $29,699.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,817.00 / $4,817.00 / $4,817.00
| Facility | | $4,817.00 | $4,817.00 | $4,817.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,625.00 / $16,181.00 / $26,424.00
| Facility | | $10,625.00 | $16,181.00 | $26,424.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $18,065.00 / $27,085.65
| Facility | | $6,098.00 | $18,065.00 | $27,085.65 |