- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,249.60 / $21,971.70 / $28,490.40
| Facility | | $14,249.60 | $21,971.70 | $28,490.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,590.40 / $21,855.00 / $29,602.08
| Facility | | $12,590.40 | $21,855.00 | $29,602.08 |
- 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
- $13,495.00 / $21,073.00 / $33,073.00
| Facility | | $13,495.00 | $21,073.00 | $33,073.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $18,065.00 / $26,997.14
| Facility | | $6,098.00 | $18,065.00 | $26,997.14 |