- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,811.20 / $15,128.10 / $19,616.40
| Facility | | $9,811.20 | $15,128.10 | $19,616.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,668.79 / $15,015.00 / $20,381.75
| Facility | | $8,668.79 | $15,015.00 | $20,381.75 |
- 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
- $6,675.00 / $10,594.00 / $15,301.00
| Facility | | $6,675.00 | $10,594.00 | $15,301.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $17,824.00 / $19,529.00
| Facility | | $6,098.00 | $17,824.00 | $19,529.00 |