- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,789.70 / $23,625.60 / $39,889.40
| Facility | | $10,789.70 | $23,625.60 | $39,889.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,429.84 / $31,752.83 / $41,428.00
| Facility | | $21,429.84 | $31,752.83 | $41,428.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,500.00 / $3,500.00 / $3,500.00
| Facility | | $3,500.00 | $3,500.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,552.16 / $33,678.67 / $49,438.40
| Facility | | $23,552.16 | $33,678.67 | $49,438.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,331.04 / $33,302.00 / $69,835.36
| Facility | | $17,331.04 | $33,302.00 | $69,835.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,552.16 / $36,668.00 / $49,710.96
| Facility | | $23,552.16 | $36,668.00 | $49,710.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,823.39 / $31,011.72 / $46,620.64
| Facility | | $6,823.39 | $31,011.72 | $46,620.64 |