- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,751.80 / $22,746.10 / $29,494.60
| Facility | | $14,751.80 | $22,746.10 | $29,494.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,034.16 / $22,625.00 / $30,645.43
| Facility | | $13,034.16 | $22,625.00 | $30,645.43 |
- 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
- $12,678.00 / $18,735.00 / $29,074.00
| Facility | | $12,678.00 | $18,735.00 | $29,074.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $18,065.00 / $27,948.67
| Facility | | $6,098.00 | $18,065.00 | $27,948.67 |