- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,996.58 / $12,434.80 / $16,235.30
| Facility | | $5,996.58 | $12,434.80 | $16,235.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,208.82 / $30,407.77
| Facility | | $5,840.42 | $11,208.82 | $30,407.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,026.05 / $11,617.73 / $17,554.53
| Facility | | $7,026.05 | $11,617.73 | $17,554.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,498.38 / $16,498.38 / $16,498.38
| Facility | | $16,498.38 | $16,498.38 | $16,498.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,123.17 / $11,703.82 / $18,073.45
| Facility | | $10,123.17 | $11,703.82 | $18,073.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,208.82 / $30,407.77
| Facility | | $5,840.42 | $11,208.82 | $30,407.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $23,763.94
| Facility | | $5,840.42 | $9,750.00 | $23,763.94 |