- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,380.90 / $20,632.20 / $26,753.60
| Facility | | $13,380.90 | $20,632.20 | $26,753.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,822.85 / $20,522.00 / $27,797.45
| Facility | | $11,822.85 | $20,522.00 | $27,797.45 |
- 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
- $10,398.00 / $15,187.00 / $23,551.00
| Facility | | $10,398.00 | $15,187.00 | $23,551.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $18,065.00 / $25,351.31
| Facility | | $6,098.00 | $18,065.00 | $25,351.31 |