- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,406.59 / $13,285.00 / $17,345.40
| Facility | | $6,406.59 | $13,285.00 | $17,345.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,975.20 / $32,486.84
| Facility | | $5,840.42 | $11,975.20 | $32,486.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,506.45 / $12,412.07 / $18,754.79
| Facility | | $7,506.45 | $12,412.07 | $18,754.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,626.41 / $17,626.41 / $17,626.41
| Facility | | $17,626.41 | $17,626.41 | $17,626.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,815.32 / $12,504.04 / $19,309.18
| Facility | | $10,815.32 | $12,504.04 | $19,309.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,975.20 / $32,486.84
| Facility | | $5,840.42 | $11,975.20 | $32,486.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $25,388.75
| Facility | | $5,840.42 | $9,750.00 | $25,388.75 |