- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,447.96 / $13,370.80 / $17,457.40
| Facility | | $6,447.96 | $13,370.80 | $17,457.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,052.54 / $32,696.65
| Facility | | $5,840.42 | $12,052.54 | $32,696.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,554.93 / $12,492.23 / $18,875.91
| Facility | | $7,554.93 | $12,492.23 | $18,875.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,740.25 / $17,740.25 / $17,740.25
| Facility | | $17,740.25 | $17,740.25 | $17,740.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,885.17 / $12,584.80 / $19,433.89
| Facility | | $10,885.17 | $12,584.80 | $19,433.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,052.54 / $32,696.65
| Facility | | $5,840.42 | $12,052.54 | $32,696.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $25,552.72
| Facility | | $5,840.42 | $9,750.00 | $25,552.72 |