- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,718.60 / $16,005.60 / $20,897.59
| Facility | | $7,718.60 | $16,005.60 | $20,897.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,427.61 / $39,139.85
| Facility | | $5,840.42 | $14,427.61 | $39,139.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,043.70 / $14,953.95 / $22,595.60
| Facility | | $9,043.70 | $14,953.95 | $22,595.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,236.15 / $21,236.15 / $21,236.15
| Facility | | $21,236.15 | $21,236.15 | $21,236.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,030.20 / $15,064.76 / $23,263.52
| Facility | | $13,030.20 | $15,064.76 | $23,263.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,427.61 / $39,139.85
| Facility | | $5,840.42 | $14,427.61 | $39,139.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,367.05 / $30,588.14
| Facility | | $5,840.42 | $11,367.05 | $30,588.14 |