- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,057.13 / $16,707.59 / $21,814.10
| Facility | | $8,057.13 | $16,707.59 | $21,814.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $15,060.40 / $40,856.51
| Facility | | $5,840.42 | $15,060.40 | $40,856.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,440.35 / $15,609.83 / $23,586.63
| Facility | | $9,440.35 | $15,609.83 | $23,586.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,167.56 / $22,167.56 / $22,167.56
| Facility | | $22,167.56 | $22,167.56 | $22,167.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,601.70 / $15,725.49 / $24,283.85
| Facility | | $13,601.70 | $15,725.49 | $24,283.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $15,060.40 / $40,856.51
| Facility | | $5,840.42 | $15,060.40 | $40,856.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,865.61 / $31,929.72
| Facility | | $5,840.42 | $11,865.61 | $31,929.72 |