- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,939.80 / $16,868.20 / $21,872.80
| Facility | | $10,939.80 | $16,868.20 | $21,872.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,665.96 / $16,778.00 / $22,726.27
| Facility | | $9,665.96 | $16,778.00 | $22,726.27 |
- 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
- $8,690.00 / $12,507.00 / $19,783.00
| Facility | | $8,690.00 | $12,507.00 | $19,783.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $18,065.00 / $20,726.39
| Facility | | $6,098.00 | $18,065.00 | $20,726.39 |