- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,341.89 / $13,150.80 / $17,170.20
| Facility | | $6,341.89 | $13,150.80 | $17,170.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,854.27 / $32,158.76
| Facility | | $5,840.42 | $11,854.27 | $32,158.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,430.64 / $12,286.73 / $18,565.39
| Facility | | $7,430.64 | $12,286.73 | $18,565.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,448.41 / $17,448.41 / $17,448.41
| Facility | | $17,448.41 | $17,448.41 | $17,448.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,706.10 / $12,377.77 / $19,114.18
| Facility | | $10,706.10 | $12,377.77 | $19,114.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,854.27 / $32,158.76
| Facility | | $5,840.42 | $11,854.27 | $32,158.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $25,132.36
| Facility | | $5,840.42 | $9,750.00 | $25,132.36 |