- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,321.94 / $17,256.70 / $22,531.10
| Facility | | $8,321.94 | $17,256.70 | $22,531.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $15,758.93 / $42,199.32
| Facility | | $5,840.42 | $15,758.93 | $42,199.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,750.62 / $16,122.87 / $24,361.84
| Facility | | $9,750.62 | $16,122.87 | $24,361.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,896.13 / $22,896.13 / $22,896.13
| Facility | | $22,896.13 | $22,896.13 | $22,896.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,048.74 / $16,242.33 / $25,081.98
| Facility | | $14,048.74 | $16,242.33 | $25,081.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $15,758.93 / $42,199.32
| Facility | | $5,840.42 | $15,758.93 | $42,199.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $15,758.93 / $32,979.14
| Facility | | $5,840.42 | $15,758.93 | $32,979.14 |