- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,741.20 / $16,562.09 / $21,475.80
| Facility | | $10,741.20 | $16,562.09 | $21,475.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,845.42 / $30,845.42 / $30,845.42
| Facility | | $30,845.42 | $30,845.42 | $30,845.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,490.53 / $16,474.00 / $22,313.78
| Facility | | $9,490.53 | $16,474.00 | $22,313.78 |
- 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
- $8,674.00 / $12,625.00 / $19,871.00
| Facility | | $8,674.00 | $12,625.00 | $19,871.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $18,065.00 / $20,350.20
| Facility | | $6,098.00 | $18,065.00 | $20,350.20 |