- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,030.80 / $16,653.00 / $21,742.80
| Facility | | $8,030.80 | $16,653.00 | $21,742.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $15,011.19 / $40,722.99
| Facility | | $5,840.42 | $15,011.19 | $40,722.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,409.50 / $15,558.81 / $23,509.55
| Facility | | $9,409.50 | $15,558.81 | $23,509.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,095.12 / $22,095.12 / $22,095.12
| Facility | | $22,095.12 | $22,095.12 | $22,095.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,557.25 / $15,674.10 / $24,204.50
| Facility | | $13,557.25 | $15,674.10 | $24,204.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $15,011.19 / $40,722.99
| Facility | | $5,840.42 | $15,011.19 | $40,722.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,826.83 / $31,825.38
| Facility | | $5,840.42 | $11,826.83 | $31,825.38 |