- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,502.88 / $13,484.60 / $17,606.09
| Facility | | $6,502.88 | $13,484.60 | $17,606.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,155.19 / $32,975.12
| Facility | | $5,840.42 | $12,155.19 | $32,975.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,619.27 / $12,598.63 / $19,036.68
| Facility | | $7,619.27 | $12,598.63 | $19,036.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,891.34 / $17,891.34 / $17,891.34
| Facility | | $17,891.34 | $17,891.34 | $17,891.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,977.88 / $12,691.99 / $19,599.41
| Facility | | $10,977.88 | $12,691.99 | $19,599.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,155.19 / $32,975.12
| Facility | | $5,840.42 | $12,155.19 | $32,975.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $25,770.36
| Facility | | $5,840.42 | $9,750.00 | $25,770.36 |