- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,716.40 / $16,523.80 / $21,426.20
| Facility | | $10,716.40 | $16,523.80 | $21,426.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,468.60 / $16,436.00 / $22,262.22
| Facility | | $9,468.60 | $16,436.00 | $22,262.22 |
- 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
- $8,479.00 / $12,332.00 / $18,813.00
| Facility | | $8,479.00 | $12,332.00 | $18,813.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $18,065.00 / $20,303.16
| Facility | | $6,098.00 | $18,065.00 | $20,303.16 |