- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,516.40 / $16,215.40 / $21,026.30
| Facility | | $10,516.40 | $16,215.40 | $21,026.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,291.87 / $16,094.00 / $21,846.70
| Facility | | $9,291.87 | $16,094.00 | $21,846.70 |
- 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
- $7,838.00 / $11,818.00 / $18,867.00
| Facility | | $7,838.00 | $11,818.00 | $18,867.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $18,065.00 / $19,924.22
| Facility | | $6,098.00 | $18,065.00 | $19,924.22 |