- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,994.13 / $14,503.30 / $19,844.00
| Facility | | $6,994.13 | $14,503.30 | $19,844.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $13,244.51 / $38,897.72
| Facility | | $5,840.42 | $13,244.51 | $38,897.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,194.86 / $13,550.38 / $20,474.78
| Facility | | $8,194.86 | $13,550.38 | $20,474.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,242.93 / $19,242.93 / $19,242.93
| Facility | | $19,242.93 | $19,242.93 | $19,242.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,807.19 / $13,650.79 / $21,080.02
| Facility | | $11,807.19 | $13,650.79 | $21,080.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $13,244.51 / $38,897.72
| Facility | | $5,840.42 | $13,244.51 | $38,897.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,300.15 / $30,867.90
| Facility | | $5,840.42 | $10,300.15 | $30,867.90 |