- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,064.29 / $12,575.20 / $16,418.59
| Facility | | $6,064.29 | $12,575.20 | $16,418.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,335.38 / $30,751.10
| Facility | | $5,840.42 | $11,335.38 | $30,751.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,105.38 / $11,748.91 / $17,752.74
| Facility | | $7,105.38 | $11,748.91 | $17,752.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,684.66 / $16,684.66 / $16,684.66
| Facility | | $16,684.66 | $16,684.66 | $16,684.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,237.46 / $11,835.97 / $18,277.50
| Facility | | $10,237.46 | $11,835.97 | $18,277.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,335.38 / $30,751.10
| Facility | | $5,840.42 | $11,335.38 | $30,751.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $24,032.26
| Facility | | $5,840.42 | $9,750.00 | $24,032.26 |