- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,179.20 / $14,887.10 / $19,437.20
| Facility | | $7,179.20 | $14,887.10 | $19,437.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $13,419.37 / $36,404.64
| Facility | | $5,840.42 | $13,419.37 | $36,404.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,411.70 / $13,908.92 / $21,016.55
| Facility | | $8,411.70 | $13,908.92 | $21,016.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,752.09 / $19,752.09 / $19,752.09
| Facility | | $19,752.09 | $19,752.09 | $19,752.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,119.61 / $14,011.99 / $21,637.80
| Facility | | $12,119.61 | $14,011.99 | $21,637.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $13,419.37 / $36,404.64
| Facility | | $5,840.42 | $13,419.37 | $36,404.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $13,419.37 / $31,684.67
| Facility | | $3,775.00 | $13,419.37 | $31,684.67 |