- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,662.87 / $9,842.87 / $21,734.00
| Facility | | $7,662.87 | $9,842.87 | $21,734.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,606.00 / $7,770.09 / $14,154.19
| Facility | | $3,606.00 | $7,770.09 | $14,154.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,020.22 / $9,146.83 / $15,459.50
| Facility | | $6,020.22 | $9,146.83 | $15,459.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,475.52 / $10,607.00 / $15,646.00
| Facility | | $8,475.52 | $10,607.00 | $15,646.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,268.75 / $10,572.06 / $19,295.00
| Facility | | $5,268.75 | $10,572.06 | $19,295.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,268.75 / $9,948.24 / $14,128.68
| Facility | | $5,268.75 | $9,948.24 | $14,128.68 |