- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,653.60 / $16,427.00 / $21,300.70
| Facility | | $10,653.60 | $16,427.00 | $21,300.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,413.12 / $16,339.00 / $22,131.80
| Facility | | $9,413.12 | $16,339.00 | $22,131.80 |
- 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
- $8,206.00 / $12,433.00 / $19,929.00
| Facility | | $8,206.00 | $12,433.00 | $19,929.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,098.00 / $18,065.00 / $20,184.23
| Facility | | $6,098.00 | $18,065.00 | $20,184.23 |