- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,022.16 / $12,487.80 / $16,304.60
| Facility | | $6,022.16 | $12,487.80 | $16,304.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,256.63 / $30,537.47
| Facility | | $5,840.42 | $11,256.63 | $30,537.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,056.02 / $11,667.29 / $17,629.41
| Facility | | $7,056.02 | $11,667.29 | $17,629.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,568.75 / $16,568.75 / $16,568.75
| Facility | | $16,568.75 | $16,568.75 | $16,568.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,166.35 / $11,753.74 / $18,150.54
| Facility | | $10,166.35 | $11,753.74 | $18,150.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,256.63 / $30,537.47
| Facility | | $5,840.42 | $11,256.63 | $30,537.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $23,865.31
| Facility | | $5,840.42 | $9,750.00 | $23,865.31 |