- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $15,848.93 / $20,892.96
| Facility | | $12,302.69 | $15,848.93 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $11,748.98 / $20,892.96
| Facility | | $3,090.30 | $11,748.98 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $14,454.40 / $24,547.09
| Facility | | $6,165.95 | $14,454.40 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $15,848.93 / $151,356.12
| Facility | | $15,848.93 | $15,848.93 | $151,356.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $16,595.87 / $23,988.33
| Facility | | $12,882.50 | $16,595.87 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $15,848.93 / $23,988.33
| Facility | | $8,709.64 | $15,848.93 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $14,454.40 / $21,877.62
| Facility | | $9,332.54 | $14,454.40 | $21,877.62 |