- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,280.00 / $23,390.60 / $30,539.80
| Facility | | $11,280.00 | $23,390.60 | $30,539.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,360.45 / $57,199.11
| Facility | | $5,840.42 | $21,360.45 | $57,199.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,216.49 / $21,853.76 / $33,021.29
| Facility | | $13,216.49 | $21,853.76 | $33,021.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,034.58 / $31,034.58 / $31,034.58
| Facility | | $31,034.58 | $31,034.58 | $31,034.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,042.38 / $22,015.69 / $33,997.40
| Facility | | $19,042.38 | $22,015.69 | $33,997.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,360.45 / $57,199.11
| Facility | | $5,840.42 | $21,360.45 | $57,199.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $21,360.45 / $44,701.61
| Facility | | $5,840.42 | $21,360.45 | $44,701.61 |