- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,742.11 / $13,980.70 / $18,253.80
| Facility | | $6,742.11 | $13,980.70 | $18,253.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,602.36 / $34,188.24
| Facility | | $5,840.42 | $12,602.36 | $34,188.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,899.57 / $13,062.12 / $19,737.00
| Facility | | $7,899.57 | $13,062.12 | $19,737.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,549.55 / $18,549.55 / $18,549.55
| Facility | | $18,549.55 | $18,549.55 | $18,549.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,381.74 / $13,158.90 / $20,320.43
| Facility | | $11,381.74 | $13,158.90 | $20,320.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,602.36 / $34,188.24
| Facility | | $5,840.42 | $12,602.36 | $34,188.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,929.00 / $26,718.41
| Facility | | $5,840.42 | $9,929.00 | $26,718.41 |