- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,558.62 / $14,738.60 / $19,111.30
| Facility | | $9,558.62 | $14,738.60 | $19,111.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,445.62 / $14,660.00 / $19,857.05
| Facility | | $8,445.62 | $14,660.00 | $19,857.05 |
- 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
- $8,022.00 / $12,060.00 / $18,841.00
| Facility | | $8,022.00 | $12,060.00 | $18,841.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $17,614.05 / $19,529.00
| Facility | | $6,098.00 | $17,614.05 | $19,529.00 |