- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,387.03 / $13,244.40 / $17,292.40
| Facility | | $6,387.03 | $13,244.40 | $17,292.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,938.64 / $48,537.00
| Facility | | $5,840.42 | $11,938.64 | $48,537.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,483.53 / $12,374.18 / $18,697.53
| Facility | | $7,483.53 | $12,374.18 | $18,697.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,572.59 / $17,572.59 / $17,572.59
| Facility | | $17,572.59 | $17,572.59 | $17,572.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,782.30 / $12,465.87 / $19,250.23
| Facility | | $10,782.30 | $12,465.87 | $19,250.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,938.64 / $48,537.00
| Facility | | $5,840.42 | $11,938.64 | $48,537.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $25,311.24
| Facility | | $5,840.42 | $9,750.00 | $25,311.24 |