- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,850.00 / $20,082.70 / $32,296.80
| Facility | | $10,850.00 | $20,082.70 | $32,296.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,512.97 / $21,512.97 / $21,512.97
| Facility | | $21,512.97 | $21,512.97 | $21,512.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,719.04 / $22,346.96 / $28,649.95
| Facility | | $15,719.04 | $22,346.96 | $28,649.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,324.34 / $20,227.09 / $38,655.55
| Facility | | $10,324.34 | $20,227.09 | $38,655.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,850.00 / $20,622.80 / $35,402.50
| Facility | | $10,850.00 | $20,622.80 | $35,402.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,700.00 / $18,938.64 / $36,956.62
| Facility | | $5,700.00 | $18,938.64 | $36,956.62 |