- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,007.87 / $12,458.20 / $16,265.90
| Facility | | $6,007.87 | $12,458.20 | $16,265.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,229.91 / $30,464.99
| Facility | | $5,840.42 | $11,229.91 | $30,464.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,039.28 / $11,639.60 / $17,587.57
| Facility | | $7,039.28 | $11,639.60 | $17,587.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,529.41 / $16,529.41 / $16,529.41
| Facility | | $16,529.41 | $16,529.41 | $16,529.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,142.21 / $11,725.84 / $18,107.46
| Facility | | $10,142.21 | $11,725.84 | $18,107.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,229.91 / $30,464.99
| Facility | | $5,840.42 | $11,229.91 | $30,464.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $23,808.66
| Facility | | $5,840.42 | $9,750.00 | $23,808.66 |