- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,520.94 / $13,522.10 / $17,655.00
| Facility | | $6,520.94 | $13,522.10 | $17,655.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,188.94 / $33,066.69
| Facility | | $5,840.42 | $12,188.94 | $33,066.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,640.43 / $12,633.61 / $19,089.54
| Facility | | $7,640.43 | $12,633.61 | $19,089.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,941.03 / $17,941.03 / $17,941.03
| Facility | | $17,941.03 | $17,941.03 | $17,941.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,008.36 / $12,727.22 / $19,653.82
| Facility | | $11,008.36 | $12,727.22 | $19,653.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,188.94 / $33,066.69
| Facility | | $5,840.42 | $12,188.94 | $33,066.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $25,841.91
| Facility | | $5,840.42 | $9,750.00 | $25,841.91 |