- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,557.05 / $13,597.00 / $17,752.70
| Facility | | $6,557.05 | $13,597.00 | $17,752.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,256.44 / $33,249.80
| Facility | | $5,840.42 | $12,256.44 | $33,249.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,682.74 / $12,703.57 / $19,195.25
| Facility | | $7,682.74 | $12,703.57 | $19,195.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,040.38 / $18,040.38 / $18,040.38
| Facility | | $18,040.38 | $18,040.38 | $18,040.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,069.32 / $12,797.70 / $19,762.66
| Facility | | $11,069.32 | $12,797.70 | $19,762.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,256.44 / $33,249.80
| Facility | | $5,840.42 | $12,256.44 | $33,249.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $25,985.01
| Facility | | $5,840.42 | $9,750.00 | $25,985.01 |