- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,074.07 / $12,595.40 / $16,445.09
| Facility | | $6,074.07 | $12,595.40 | $16,445.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,353.66 / $30,800.70
| Facility | | $5,840.42 | $11,353.66 | $30,800.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,116.84 / $11,767.86 / $17,781.37
| Facility | | $7,116.84 | $11,767.86 | $17,781.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,711.57 / $16,711.57 / $16,711.57
| Facility | | $16,711.57 | $16,711.57 | $16,711.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,253.98 / $11,855.05 / $18,306.99
| Facility | | $10,253.98 | $11,855.05 | $18,306.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,353.66 / $30,800.70
| Facility | | $5,840.42 | $11,353.66 | $30,800.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $24,071.02
| Facility | | $5,840.42 | $9,750.00 | $24,071.02 |