- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,268.60 / $22,001.00 / $28,528.40
| Facility | | $14,268.60 | $22,001.00 | $28,528.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,607.17 / $21,884.00 / $29,641.51
| Facility | | $12,607.17 | $21,884.00 | $29,641.51 |
- 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
- $11,309.00 / $16,446.00 / $25,936.00
| Facility | | $11,309.00 | $16,446.00 | $25,936.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,909.00 / $15,162.81 / $26,293.28
| Facility | | $6,909.00 | $15,162.81 | $26,293.28 |