- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,344.71 / $15,230.30 / $19,885.30
| Facility | | $7,344.71 | $15,230.30 | $19,885.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $13,728.73 / $37,243.89
| Facility | | $5,840.42 | $13,728.73 | $37,243.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,605.62 / $14,229.57 / $21,501.05
| Facility | | $8,605.62 | $14,229.57 | $21,501.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,207.46 / $20,207.46 / $20,207.46
| Facility | | $20,207.46 | $20,207.46 | $20,207.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,399.01 / $14,335.01 / $22,136.63
| Facility | | $12,399.01 | $14,335.01 | $22,136.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $13,728.73 / $37,243.89
| Facility | | $5,840.42 | $13,728.73 | $37,243.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,816.43 / $29,106.43
| Facility | | $5,840.42 | $10,816.43 | $29,106.43 |