- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,683.40 / $25,625.00 / $33,356.60
| Facility | | $16,683.40 | $25,625.00 | $33,356.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,740.83 / $25,587.00 / $34,658.08
| Facility | | $14,740.83 | $25,587.00 | $34,658.08 |
- 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
- $12,619.00 / $18,683.00 / $28,586.00
| Facility | | $12,619.00 | $18,683.00 | $28,586.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $18,065.00 / $31,608.22
| Facility | | $6,098.00 | $18,065.00 | $31,608.22 |