- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,575.85 / $13,636.00 / $17,803.70
| Facility | | $6,575.85 | $13,636.00 | $17,803.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,291.59 / $33,345.17
| Facility | | $5,840.42 | $12,291.59 | $33,345.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,704.77 / $12,740.01 / $19,250.30
| Facility | | $7,704.77 | $12,740.01 | $19,250.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,092.12 / $18,092.12 / $18,092.12
| Facility | | $18,092.12 | $18,092.12 | $18,092.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,101.07 / $12,834.41 / $19,819.34
| Facility | | $11,101.07 | $12,834.41 | $19,819.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,291.59 / $33,345.17
| Facility | | $5,840.42 | $12,291.59 | $33,345.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $26,059.54
| Facility | | $5,840.42 | $9,750.00 | $26,059.54 |