- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,945.79 / $16,476.70 / $21,512.70
| Facility | | $7,945.79 | $16,476.70 | $21,512.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,852.28 / $40,291.92
| Facility | | $5,840.42 | $14,852.28 | $40,291.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,309.90 / $15,394.12 / $23,260.69
| Facility | | $9,309.90 | $15,394.12 | $23,260.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,861.23 / $21,861.23 / $21,861.23
| Facility | | $21,861.23 | $21,861.23 | $21,861.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,413.74 / $15,508.18 / $23,948.28
| Facility | | $13,413.74 | $15,508.18 | $23,948.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,852.28 / $40,291.92
| Facility | | $5,840.42 | $14,852.28 | $40,291.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,701.64 / $31,488.49
| Facility | | $5,840.42 | $11,701.64 | $31,488.49 |