- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.00 / $16,758.70 / $23,684.30
| Facility | | $4,098.00 | $16,758.70 | $23,684.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,292.64 / $12,404.97 / $20,452.00
| Facility | | $4,292.64 | $12,404.97 | $20,452.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,501.85 / $22,098.42 / $30,802.66
| Facility | | $14,501.85 | $22,098.42 | $30,802.66 |
- 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
- $13,411.00 / $19,928.66 / $27,069.80
| Facility | | $13,411.00 | $19,928.66 | $27,069.80 |