- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,192.93 / $12,841.90 / $16,766.90
| Facility | | $6,192.93 | $12,841.90 | $16,766.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,575.84 / $31,403.43
| Facility | | $5,840.42 | $11,575.84 | $31,403.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,256.11 / $11,998.14 / $18,129.33
| Facility | | $7,256.11 | $11,998.14 | $18,129.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,038.59 / $17,038.59 / $17,038.59
| Facility | | $17,038.59 | $17,038.59 | $17,038.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,454.64 / $12,087.05 / $18,665.24
| Facility | | $10,454.64 | $12,087.05 | $18,665.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,575.84 / $31,403.43
| Facility | | $5,840.42 | $11,575.84 | $31,403.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $24,542.06
| Facility | | $5,840.42 | $9,750.00 | $24,542.06 |