- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,531.60 / $11,411.60 / $16,359.00
| Facility | | $6,531.60 | $11,411.60 | $16,359.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,534.00 / $15,221.97 / $20,946.00
| Facility | | $8,534.00 | $15,221.97 | $20,946.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,058.13 / $10,798.32 / $15,628.00
| Facility | | $6,058.13 | $10,798.32 | $15,628.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,406.07 / $11,406.07 / $13,850.23
| Facility | | $11,406.07 | $11,406.07 | $13,850.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,242.26 / $11,411.60 / $16,173.90
| Facility | | $6,242.26 | $11,411.60 | $16,173.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,700.27 / $10,126.89 / $15,620.28
| Facility | | $5,700.27 | $10,126.89 | $15,620.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,621.40 / $6,037.62 / $8,234.71
| Facility | | $2,621.40 | $6,037.62 | $8,234.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,185.72 / $9,964.91 / $18,053.96
| Facility | | $4,185.72 | $9,964.91 | $18,053.96 |