- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,145.00 / $16,659.00 / $22,295.50
| Facility | | $4,145.00 | $16,659.00 | $22,295.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $15,244.64 / $40,822.17
| Facility | | $5,840.42 | $15,244.64 | $40,822.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,069.62 / $15,596.71 / $23,566.81
| Facility | | $9,069.62 | $15,596.71 | $23,566.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,148.93 / $22,148.93 / $22,148.93
| Facility | | $22,148.93 | $22,148.93 | $22,148.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,590.27 / $15,712.28 / $24,263.45
| Facility | | $13,590.27 | $15,712.28 | $24,263.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $15,244.64 / $40,822.17
| Facility | | $5,840.42 | $15,244.64 | $40,822.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,855.64 / $31,902.89
| Facility | | $5,840.42 | $11,855.64 | $31,902.89 |