- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,290.73 / $13,044.70 / $17,031.70
| Facility | | $6,290.73 | $13,044.70 | $17,031.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,758.64 / $31,899.36
| Facility | | $5,840.42 | $11,758.64 | $31,899.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,370.70 / $12,187.62 / $18,415.63
| Facility | | $7,370.70 | $12,187.62 | $18,415.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,307.66 / $17,307.66 / $17,307.66
| Facility | | $17,307.66 | $17,307.66 | $17,307.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,619.74 / $12,277.92 / $18,960.00
| Facility | | $10,619.74 | $12,277.92 | $18,960.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,758.64 / $31,899.36
| Facility | | $5,840.42 | $11,758.64 | $31,899.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $24,929.63
| Facility | | $5,840.42 | $9,750.00 | $24,929.63 |