- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,090.10 / $15,558.00 / $20,173.90
| Facility | | $10,090.10 | $15,558.00 | $20,173.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,915.19 / $15,475.00 / $20,961.06
| Facility | | $8,915.19 | $15,475.00 | $20,961.06 |
- 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
- $7,609.00 / $11,147.00 / $17,126.00
| Facility | | $7,609.00 | $11,147.00 | $17,126.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $17,914.68 / $19,529.00
| Facility | | $6,098.00 | $17,914.68 | $19,529.00 |