- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,056.02 / $12,558.00 / $16,396.20
| Facility | | $6,056.02 | $12,558.00 | $16,396.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,319.91 / $30,709.14
| Facility | | $5,840.42 | $11,319.91 | $30,709.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,095.69 / $11,732.88 / $17,728.52
| Facility | | $7,095.69 | $11,732.88 | $17,728.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,661.89 / $16,661.89 / $16,661.89
| Facility | | $16,661.89 | $16,661.89 | $16,661.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,223.50 / $11,819.82 / $18,252.57
| Facility | | $10,223.50 | $11,819.82 | $18,252.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,319.91 / $30,709.14
| Facility | | $5,840.42 | $11,319.91 | $30,709.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $23,999.47
| Facility | | $5,840.42 | $9,750.00 | $23,999.47 |