- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.00 / $17,051.00 / $27,587.20
| Facility | | $4,098.00 | $17,051.00 | $27,587.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,292.64 / $13,495.00 / $22,426.00
| Facility | | $4,292.64 | $13,495.00 | $22,426.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,891.59 / $25,740.01 / $35,878.61
| Facility | | $16,891.59 | $25,740.01 | $35,878.61 |
- 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 / $21,865.00 / $31,850.02
| Facility | | $10,845.00 | $21,865.00 | $31,850.02 |