- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,925.60 / $23,014.00 / $29,842.00
| Facility | | $14,925.60 | $23,014.00 | $29,842.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,187.67 / $22,891.00 / $31,006.36
| Facility | | $13,187.67 | $22,891.00 | $31,006.36 |
- 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
- $11,547.00 / $17,173.00 / $27,241.00
| Facility | | $11,547.00 | $17,173.00 | $27,241.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $18,764.00 / $28,277.84
| Facility | | $6,098.00 | $18,764.00 | $28,277.84 |