- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,388.20 / $19,873.90 / $40,378.30
| Facility | | $10,388.20 | $19,873.90 | $40,378.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,378.18 / $30,378.18 / $32,276.25
| Facility | | $30,378.18 | $30,378.18 | $32,276.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,500.00 / $11,740.25 / $18,882.28
| Facility | | $7,500.00 | $11,740.25 | $18,882.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,500.00 / $11,968.84 / $32,276.25
| Facility | | $7,500.00 | $11,968.84 | $32,276.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,762.00 / $9,762.00 / $9,762.00
| Facility | | $9,762.00 | $9,762.00 | $9,762.00 |