- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,531.10 / $17,780.00 / $23,055.10
| Facility | | $11,531.10 | $17,780.00 | $23,055.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,188.42 / $17,685.00 / $23,954.63
| Facility | | $10,188.42 | $17,685.00 | $23,954.63 |
- 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
- $9,529.00 / $13,881.00 / $21,883.00
| Facility | | $9,529.00 | $13,881.00 | $21,883.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $18,065.00 / $21,846.66
| Facility | | $6,098.00 | $18,065.00 | $21,846.66 |