- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,790.26 / $14,080.60 / $18,384.20
| Facility | | $6,790.26 | $14,080.60 | $18,384.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,692.36 / $34,432.37
| Facility | | $5,840.42 | $12,692.36 | $34,432.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,955.99 / $13,155.40 / $19,877.96
| Facility | | $7,955.99 | $13,155.40 | $19,877.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,682.00 / $18,682.00 / $18,682.00
| Facility | | $18,682.00 | $18,682.00 | $18,682.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,463.02 / $13,252.88 / $20,465.55
| Facility | | $11,463.02 | $13,252.88 | $20,465.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,692.36 / $34,432.37
| Facility | | $5,840.42 | $12,692.36 | $34,432.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,999.91 / $26,909.21
| Facility | | $5,840.42 | $9,999.91 | $26,909.21 |