- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,110.00 / $23,038.10 / $30,079.50
| Facility | | $11,110.00 | $23,038.10 | $30,079.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $20,766.75 / $56,336.97
| Facility | | $5,840.42 | $20,766.75 | $56,336.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,017.28 / $21,524.36 / $32,523.57
| Facility | | $13,017.28 | $21,524.36 | $32,523.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,566.81 / $30,566.81 / $30,566.81
| Facility | | $30,566.81 | $30,566.81 | $30,566.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,755.36 / $21,683.85 / $33,484.96
| Facility | | $18,755.36 | $21,683.85 | $33,484.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $20,766.75 / $56,336.97
| Facility | | $5,840.42 | $20,766.75 | $56,336.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $16,361.47 / $44,027.84
| Facility | | $5,840.42 | $16,361.47 | $44,027.84 |