- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,507.60 / $16,201.90 / $21,008.80
| Facility | | $10,507.60 | $16,201.90 | $21,008.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,284.12 / $16,116.00 / $21,828.50
| Facility | | $9,284.12 | $16,116.00 | $21,828.50 |
- 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
- $8,400.00 / $12,143.00 / $18,846.00
| Facility | | $8,400.00 | $12,143.00 | $18,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $18,065.00 / $19,907.62
| Facility | | $6,098.00 | $18,065.00 | $19,907.62 |