- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,907.62 / $14,323.90 / $18,701.90
| Facility | | $6,907.62 | $14,323.90 | $18,701.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,911.73 / $35,027.49
| Facility | | $5,840.42 | $12,911.73 | $35,027.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,093.49 / $13,382.77 / $20,221.52
| Facility | | $8,093.49 | $13,382.77 | $20,221.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,004.90 / $19,004.90 / $19,004.90
| Facility | | $19,004.90 | $19,004.90 | $19,004.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,661.14 / $13,481.93 / $20,819.27
| Facility | | $11,661.14 | $13,481.93 | $20,819.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,911.73 / $35,027.49
| Facility | | $5,840.42 | $12,911.73 | $35,027.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,172.74 / $27,374.30
| Facility | | $5,840.42 | $10,172.74 | $27,374.30 |