- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,009.37 / $12,461.30 / $16,270.00
| Facility | | $6,009.37 | $12,461.30 | $16,270.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,232.73 / $30,472.62
| Facility | | $5,840.42 | $11,232.73 | $30,472.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,041.04 / $11,642.51 / $17,591.97
| Facility | | $7,041.04 | $11,642.51 | $17,591.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,533.56 / $16,533.56 / $16,533.56
| Facility | | $16,533.56 | $16,533.56 | $16,533.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,144.76 / $11,728.78 / $18,111.99
| Facility | | $10,144.76 | $11,728.78 | $18,111.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,232.73 / $30,472.62
| Facility | | $5,840.42 | $11,232.73 | $30,472.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $23,814.62
| Facility | | $5,840.42 | $9,750.00 | $23,814.62 |