- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,990.56 / $12,422.30 / $16,219.00
| Facility | | $5,990.56 | $12,422.30 | $16,219.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,197.57 / $30,377.25
| Facility | | $5,840.42 | $11,197.57 | $30,377.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,019.00 / $11,606.07 / $17,536.91
| Facility | | $7,019.00 | $11,606.07 | $17,536.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,481.82 / $16,481.82 / $16,481.82
| Facility | | $16,481.82 | $16,481.82 | $16,481.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,113.01 / $11,692.07 / $18,055.31
| Facility | | $10,113.01 | $11,692.07 | $18,055.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,197.57 / $30,377.25
| Facility | | $5,840.42 | $11,197.57 | $30,377.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $23,740.09
| Facility | | $5,840.42 | $9,750.00 | $23,740.09 |