- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,471.65 / $17,567.20 / $22,936.40
| Facility | | $8,471.65 | $17,567.20 | $22,936.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $15,835.22 / $42,958.46
| Facility | | $5,840.42 | $15,835.22 | $42,958.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,926.03 / $16,412.91 / $24,800.10
| Facility | | $9,926.03 | $16,412.91 | $24,800.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,308.02 / $23,308.02 / $23,308.02
| Facility | | $23,308.02 | $23,308.02 | $23,308.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,301.47 / $16,534.53 / $25,533.19
| Facility | | $14,301.47 | $16,534.53 | $25,533.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $15,835.22 / $42,958.46
| Facility | | $5,840.42 | $15,835.22 | $42,958.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,476.06 / $33,572.42
| Facility | | $5,840.42 | $12,476.06 | $33,572.42 |