- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,247.70 / $15,801.20 / $20,489.20
| Facility | | $10,247.70 | $15,801.20 | $20,489.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,054.51 / $15,717.00 / $21,288.63
| Facility | | $9,054.51 | $15,717.00 | $21,288.63 |
- 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
- $7,798.00 / $11,308.00 / $18,322.00
| Facility | | $7,798.00 | $11,308.00 | $18,322.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $18,065.00 / $19,529.00
| Facility | | $6,098.00 | $18,065.00 | $19,529.00 |