- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,248.60 / $12,957.40 / $16,917.70
| Facility | | $6,248.60 | $12,957.40 | $16,917.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,679.90 / $31,685.73
| Facility | | $5,840.42 | $11,679.90 | $31,685.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,321.34 / $12,106.00 / $18,292.30
| Facility | | $7,321.34 | $12,106.00 | $18,292.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,191.75 / $17,191.75 / $17,191.75
| Facility | | $17,191.75 | $17,191.75 | $17,191.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,548.62 / $12,195.70 / $18,833.02
| Facility | | $10,548.62 | $12,195.70 | $18,833.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,679.90 / $31,685.73
| Facility | | $5,840.42 | $11,679.90 | $31,685.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $11,679.90 / $27,577.58
| Facility | | $3,775.00 | $11,679.90 | $27,577.58 |