- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,047.74 / $12,540.80 / $16,373.80
| Facility | | $6,047.74 | $12,540.80 | $16,373.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,304.44 / $30,667.18
| Facility | | $5,840.42 | $11,304.44 | $30,667.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,085.99 / $11,716.84 / $17,704.29
| Facility | | $7,085.99 | $11,716.84 | $17,704.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,639.12 / $16,639.12 / $16,639.12
| Facility | | $16,639.12 | $16,639.12 | $16,639.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,209.53 / $11,803.66 / $18,227.63
| Facility | | $10,209.53 | $11,803.66 | $18,227.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,304.44 / $30,667.18
| Facility | | $5,840.42 | $11,304.44 | $30,667.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $11,304.44 / $26,691.09
| Facility | | $3,775.00 | $11,304.44 | $26,691.09 |