- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,804.40 / $22,827.20 / $29,599.70
| Facility | | $14,804.40 | $22,827.20 | $29,599.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,080.60 / $22,705.00 / $30,754.62
| Facility | | $13,080.60 | $22,705.00 | $30,754.62 |
- 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
- $11,481.00 / $16,716.00 / $25,788.00
| Facility | | $11,481.00 | $16,716.00 | $25,788.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $18,065.00 / $28,048.25
| Facility | | $6,098.00 | $18,065.00 | $28,048.25 |