- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,402.50 / $16,039.80 / $20,798.59
| Facility | | $10,402.50 | $16,039.80 | $20,798.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,191.25 / $15,954.00 / $21,610.13
| Facility | | $9,191.25 | $15,954.00 | $21,610.13 |
- 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
- $7,173.00 / $10,583.00 / $16,226.00
| Facility | | $7,173.00 | $10,583.00 | $16,226.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $9,062.00 / $19,708.46
| Facility | | $6,098.00 | $9,062.00 | $19,708.46 |