- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,244.84 / $12,949.60 / $16,907.50
| Facility | | $6,244.84 | $12,949.60 | $16,907.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,672.87 / $31,666.65
| Facility | | $5,840.42 | $11,672.87 | $31,666.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,316.93 / $12,098.71 / $18,281.29
| Facility | | $7,316.93 | $12,098.71 | $18,281.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,181.41 / $17,181.41 / $17,181.41
| Facility | | $17,181.41 | $17,181.41 | $17,181.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,542.27 / $12,188.36 / $18,821.68
| Facility | | $10,542.27 | $12,188.36 | $18,821.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,672.87 / $31,666.65
| Facility | | $5,840.42 | $11,672.87 | $31,666.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $24,747.77
| Facility | | $5,840.42 | $9,750.00 | $24,747.77 |