- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,755.60 / $20,576.70 / $41,806.30
| Facility | | $10,755.60 | $20,576.70 | $41,806.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,452.48 / $31,452.48 / $33,417.68
| Facility | | $31,452.48 | $31,452.48 | $33,417.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,415.00 / $7,415.00 / $7,415.00
| Facility | | $7,415.00 | $7,415.00 | $7,415.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,500.00 / $12,155.44 / $19,169.30
| Facility | | $7,500.00 | $12,155.44 | $19,169.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,500.00 / $12,150.77 / $33,417.68
| Facility | | $7,500.00 | $12,150.77 | $33,417.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,107.00 / $10,107.00 / $10,107.00
| Facility | | $10,107.00 | $10,107.00 | $10,107.00 |