- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,579.42 / $15,717.00 / $20,520.80
| Facility | | $7,579.42 | $15,717.00 | $20,520.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,167.47 / $38,434.11
| Facility | | $5,840.42 | $14,167.47 | $38,434.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,880.62 / $14,684.31 / $22,188.17
| Facility | | $8,880.62 | $14,684.31 | $22,188.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,853.24 / $20,853.24 / $20,853.24
| Facility | | $20,853.24 | $20,853.24 | $20,853.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,795.25 / $14,793.12 / $22,844.06
| Facility | | $12,795.25 | $14,793.12 | $22,844.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,167.47 / $38,434.11
| Facility | | $5,840.42 | $14,167.47 | $38,434.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,162.09 / $30,036.60
| Facility | | $5,840.42 | $11,162.09 | $30,036.60 |