- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,690.76 / $15,947.90 / $20,822.20
| Facility | | $7,690.76 | $15,947.90 | $20,822.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,563.69 / $39,000.00
| Facility | | $5,840.42 | $14,563.69 | $39,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,011.08 / $14,900.02 / $22,514.11
| Facility | | $9,011.08 | $14,900.02 | $22,514.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,159.57 / $21,159.57 / $21,159.57
| Facility | | $21,159.57 | $21,159.57 | $21,159.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,983.21 / $15,010.43 / $23,179.63
| Facility | | $12,983.21 | $15,010.43 | $23,179.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,563.69 / $39,000.00
| Facility | | $5,840.42 | $14,563.69 | $39,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,563.69 / $30,477.83
| Facility | | $5,840.42 | $14,563.69 | $30,477.83 |