- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,626.00 / $17,926.30 / $23,244.80
| Facility | | $11,626.00 | $17,926.30 | $23,244.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,272.27 / $17,793.00 / $24,151.78
| Facility | | $10,272.27 | $17,793.00 | $24,151.78 |
- 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
- $8,445.00 / $12,438.00 / $19,629.00
| Facility | | $8,445.00 | $12,438.00 | $19,629.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $18,065.00 / $22,026.45
| Facility | | $6,098.00 | $18,065.00 | $22,026.45 |