- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,736.00 / $25,705.80 / $33,461.60
| Facility | | $16,736.00 | $25,705.80 | $33,461.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,787.27 / $25,668.00 / $34,767.28
| Facility | | $14,787.27 | $25,668.00 | $34,767.28 |
- 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
- $12,764.00 / $19,489.00 / $31,424.00
| Facility | | $12,764.00 | $19,489.00 | $31,424.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $19,203.00 / $31,707.80
| Facility | | $6,098.00 | $19,203.00 | $31,707.80 |