- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,258.02 / $8,829.60 / $11,528.30
| Facility | | $4,258.02 | $8,829.60 | $11,528.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,733.58 / $8,063.24 / $48,537.00
| Facility | | $5,733.58 | $8,063.24 | $48,537.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,989.02 / $8,249.45 / $12,465.02
| Facility | | $4,989.02 | $8,249.45 | $12,465.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,715.07 / $11,715.07 / $11,715.07
| Facility | | $11,715.07 | $11,715.07 | $11,715.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,188.20 / $8,310.58 / $12,833.48
| Facility | | $7,188.20 | $8,310.58 | $12,833.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,733.58 / $8,063.24 / $48,537.00
| Facility | | $5,733.58 | $8,063.24 | $48,537.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,733.58 / $7,959.09 / $16,874.16
| Facility | | $5,733.58 | $7,959.09 | $16,874.16 |