- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,945.43 / $12,328.70 / $16,096.80
| Facility | | $5,945.43 | $12,328.70 | $16,096.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,113.20 / $30,148.36
| Facility | | $5,840.42 | $11,113.20 | $30,148.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,966.12 / $11,518.62 / $17,404.78
| Facility | | $6,966.12 | $11,518.62 | $17,404.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,357.63 / $16,357.63 / $16,357.63
| Facility | | $16,357.63 | $16,357.63 | $16,357.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,036.81 / $11,603.97 / $17,919.25
| Facility | | $10,036.81 | $11,603.97 | $17,919.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,113.20 / $30,148.36
| Facility | | $5,840.42 | $11,113.20 | $30,148.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $23,561.21
| Facility | | $5,840.42 | $9,750.00 | $23,561.21 |