- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,908.00 / $18,728.80 / $25,163.30
| Facility | | $4,908.00 | $18,728.80 | $25,163.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,355.62 / $21,447.00 / $29,050.07
| Facility | | $12,355.62 | $21,447.00 | $29,050.07 |
- 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
- $10,292.00 / $15,521.00 / $21,942.00
| Facility | | $10,292.00 | $15,521.00 | $21,942.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,909.00 / $18,764.00 / $26,493.71
| Facility | | $6,909.00 | $18,764.00 | $26,493.71 |