- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,207.98 / $12,873.10 / $16,807.70
| Facility | | $6,207.98 | $12,873.10 | $16,807.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,603.96 / $31,479.73
| Facility | | $5,840.42 | $11,603.96 | $31,479.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,273.74 / $12,027.29 / $18,173.38
| Facility | | $7,273.74 | $12,027.29 | $18,173.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,498.66 / $15,498.66 / $15,498.66
| Facility | | $15,498.66 | $15,498.66 | $15,498.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,480.04 / $12,116.41 / $18,710.58
| Facility | | $10,480.04 | $12,116.41 | $18,710.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,603.96 / $31,479.73
| Facility | | $5,840.42 | $11,603.96 | $31,479.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $11,603.96 / $27,398.29
| Facility | | $3,775.00 | $11,603.96 | $27,398.29 |