- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,512.00 / $16,208.60 / $21,017.50
| Facility | | $10,512.00 | $16,208.60 | $21,017.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,288.00 / $16,122.00 / $21,837.60
| Facility | | $9,288.00 | $16,122.00 | $21,837.60 |
- 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
- $8,137.00 / $11,728.00 / $18,858.00
| Facility | | $8,137.00 | $11,728.00 | $18,858.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $18,065.00 / $19,915.91
| Facility | | $6,098.00 | $18,065.00 | $19,915.91 |