- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,839.59 / $25,865.00 / $33,668.90
| Facility | | $16,839.59 | $25,865.00 | $33,668.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,878.86 / $25,827.00 / $34,982.62
| Facility | | $14,878.86 | $25,827.00 | $34,982.62 |
- 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
- $13,054.00 / $19,725.00 / $31,294.00
| Facility | | $13,054.00 | $19,725.00 | $31,294.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $18,065.00 / $31,904.20
| Facility | | $6,098.00 | $18,065.00 | $31,904.20 |