- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,089.87 / $12,628.20 / $16,487.90
| Facility | | $6,089.87 | $12,628.20 | $16,487.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,383.19 / $30,880.81
| Facility | | $5,840.42 | $11,383.19 | $30,880.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,135.35 / $11,798.46 / $17,827.62
| Facility | | $7,135.35 | $11,798.46 | $17,827.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,755.03 / $16,755.03 / $16,755.03
| Facility | | $16,755.03 | $16,755.03 | $16,755.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,280.65 / $11,885.89 / $18,354.59
| Facility | | $10,280.65 | $11,885.89 | $18,354.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,383.19 / $30,880.81
| Facility | | $5,840.42 | $11,383.19 | $30,880.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $24,133.62
| Facility | | $5,840.42 | $9,750.00 | $24,133.62 |