- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,121.08 / $16,840.20 / $21,987.30
| Facility | | $8,121.08 | $16,840.20 | $21,987.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $15,378.56 / $41,180.76
| Facility | | $5,840.42 | $15,378.56 | $41,180.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,515.27 / $15,733.71 / $23,773.83
| Facility | | $9,515.27 | $15,733.71 | $23,773.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,343.49 / $22,343.49 / $22,343.49
| Facility | | $22,343.49 | $22,343.49 | $22,343.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,709.65 / $15,850.30 / $24,476.58
| Facility | | $13,709.65 | $15,850.30 | $24,476.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $15,378.56 / $41,180.76
| Facility | | $5,840.42 | $15,378.56 | $41,180.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $15,595.54 / $35,841.56
| Facility | | $5,840.42 | $15,595.54 | $35,841.56 |