- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,941.67 / $12,320.90 / $16,086.60
| Facility | | $5,941.67 | $12,320.90 | $16,086.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,106.17 / $30,129.29
| Facility | | $5,840.42 | $11,106.17 | $30,129.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,961.71 / $11,511.34 / $17,393.77
| Facility | | $6,961.71 | $11,511.34 | $17,393.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,347.28 / $16,347.28 / $16,347.28
| Facility | | $16,347.28 | $16,347.28 | $16,347.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,030.45 / $11,596.63 / $17,907.93
| Facility | | $10,030.45 | $11,596.63 | $17,907.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,106.17 / $30,129.29
| Facility | | $5,840.42 | $11,106.17 | $30,129.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $23,546.31
| Facility | | $5,840.42 | $9,750.00 | $23,546.31 |