- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,882.60 / $16,345.70 / $21,341.60
| Facility | | $7,882.60 | $16,345.70 | $21,341.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,734.16 / $39,971.47
| Facility | | $5,840.42 | $14,734.16 | $39,971.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,235.85 / $15,271.69 / $23,075.70
| Facility | | $9,235.85 | $15,271.69 | $23,075.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,687.36 / $21,687.36 / $21,687.36
| Facility | | $21,687.36 | $21,687.36 | $21,687.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,307.06 / $15,384.85 / $23,757.82
| Facility | | $13,307.06 | $15,384.85 | $23,757.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,734.16 / $39,971.47
| Facility | | $5,840.42 | $14,734.16 | $39,971.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,608.58 / $31,238.06
| Facility | | $5,840.42 | $11,608.58 | $31,238.06 |