- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,291.48 / $13,046.30 / $17,033.80
| Facility | | $6,291.48 | $13,046.30 | $17,033.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,760.05 / $31,903.17
| Facility | | $5,840.42 | $11,760.05 | $31,903.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,371.58 / $12,189.07 / $18,417.83
| Facility | | $7,371.58 | $12,189.07 | $18,417.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,309.74 / $17,309.74 / $17,309.74
| Facility | | $17,309.74 | $17,309.74 | $17,309.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,621.01 / $12,279.39 / $18,962.27
| Facility | | $10,621.01 | $12,279.39 | $18,962.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,760.05 / $31,903.17
| Facility | | $5,840.42 | $11,760.05 | $31,903.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $11,760.05 / $27,766.83
| Facility | | $3,775.00 | $11,760.05 | $27,766.83 |