- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,150.00 / $21,047.50 / $27,480.50
| Facility | | $10,150.00 | $21,047.50 | $27,480.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,220.70 / $51,469.28
| Facility | | $5,840.42 | $19,220.70 | $51,469.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,892.55 / $19,664.59 / $29,713.43
| Facility | | $11,892.55 | $19,664.59 | $29,713.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,829.32 / $24,829.32 / $24,829.32
| Facility | | $24,829.32 | $24,829.32 | $24,829.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,134.84 / $19,810.30 / $30,591.76
| Facility | | $17,134.84 | $19,810.30 | $30,591.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,220.70 / $51,469.28
| Facility | | $5,840.42 | $19,220.70 | $51,469.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $19,220.70 / $40,223.69
| Facility | | $5,840.42 | $19,220.70 | $40,223.69 |