- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,511.20 / $17,422.20 / $24,668.00
| Facility | | $9,511.20 | $17,422.20 | $24,668.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,217.20 / $45,217.20 / $45,217.20
| Facility | | $45,217.20 | $45,217.20 | $45,217.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,446.95 / $16,939.32 / $27,226.39
| Facility | | $10,446.95 | $16,939.32 | $27,226.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,888.78 / $15,672.22 / $27,883.36
| Facility | | $9,888.78 | $15,672.22 | $27,883.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,292.86 / $14,786.72 / $32,972.12
| Facility | | $6,292.86 | $14,786.72 | $32,972.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,292.86 / $15,278.17 / $32,972.12
| Facility | | $6,292.86 | $15,278.17 | $32,972.12 |