- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,430.66 / $13,334.90 / $17,410.59
| Facility | | $6,430.66 | $13,334.90 | $17,410.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,020.20 / $32,608.91
| Facility | | $5,840.42 | $12,020.20 | $32,608.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,534.65 / $12,458.71 / $18,825.25
| Facility | | $7,534.65 | $12,458.71 | $18,825.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,692.65 / $17,692.65 / $17,692.65
| Facility | | $17,692.65 | $17,692.65 | $17,692.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,855.96 / $12,551.03 / $19,381.74
| Facility | | $10,855.96 | $12,551.03 | $19,381.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,020.20 / $32,608.91
| Facility | | $5,840.42 | $12,020.20 | $32,608.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $25,484.15
| Facility | | $5,840.42 | $9,750.00 | $25,484.15 |