- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,964.60 / $16,515.70 / $21,563.60
| Facility | | $7,964.60 | $16,515.70 | $21,563.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,887.44 / $40,387.29
| Facility | | $5,840.42 | $14,887.44 | $40,387.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,331.93 / $15,430.55 / $23,315.75
| Facility | | $9,331.93 | $15,430.55 | $23,315.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,912.97 / $21,912.97 / $21,912.97
| Facility | | $21,912.97 | $21,912.97 | $21,912.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,445.49 / $15,544.89 / $24,004.96
| Facility | | $13,445.49 | $15,544.89 | $24,004.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,887.44 / $40,387.29
| Facility | | $5,840.42 | $14,887.44 | $40,387.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,729.34 / $31,563.02
| Facility | | $5,840.42 | $11,729.34 | $31,563.02 |