- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,505.52 / $9,342.84 / $12,478.10
| Facility | | $4,505.52 | $9,342.84 | $12,478.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,652.31 / $48,537.00
| Facility | | $5,840.42 | $8,652.31 | $48,537.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,075.97 / $8,666.68 / $13,189.57
| Facility | | $5,075.97 | $8,666.68 | $13,189.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,396.03 / $12,396.03 / $12,396.03
| Facility | | $12,396.03 | $12,396.03 | $12,396.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,606.03 / $8,793.65 / $13,579.46
| Facility | | $7,606.03 | $8,793.65 | $13,579.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,652.31 / $48,537.00
| Facility | | $5,840.42 | $8,652.31 | $48,537.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,421.73 / $19,884.68
| Facility | | $5,840.42 | $8,421.73 | $19,884.68 |