- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,698.29 / $15,963.50 / $20,842.59
| Facility | | $7,698.29 | $15,963.50 | $20,842.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,389.64 / $39,036.85
| Facility | | $5,840.42 | $14,389.64 | $39,036.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,019.90 / $14,914.60 / $22,536.14
| Facility | | $9,019.90 | $14,914.60 | $22,536.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,180.26 / $21,180.26 / $21,180.26
| Facility | | $21,180.26 | $21,180.26 | $21,180.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,995.91 / $15,025.11 / $23,202.30
| Facility | | $12,995.91 | $15,025.11 | $23,202.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $14,389.64 / $39,036.85
| Facility | | $5,840.42 | $14,389.64 | $39,036.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $14,389.64 / $33,975.61
| Facility | | $3,775.00 | $14,389.64 | $33,975.61 |