- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.00 / $16,741.20 / $23,659.60
| Facility | | $4,098.00 | $16,741.20 | $23,659.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,292.64 / $12,146.00 / $20,379.00
| Facility | | $4,292.64 | $12,146.00 | $20,379.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,486.73 / $22,075.37 / $30,770.53
| Facility | | $14,486.73 | $22,075.37 | $30,770.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,500.00 / $12,500.00 / $12,500.00
| Facility | | $12,500.00 | $12,500.00 | $12,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,845.00 / $19,907.87 / $27,315.50
| Facility | | $10,845.00 | $19,907.87 | $27,315.50 |