- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,791.01 / $14,082.10 / $18,386.20
| Facility | | $6,791.01 | $14,082.10 | $18,386.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,693.77 / $34,436.19
| Facility | | $5,840.42 | $12,693.77 | $34,436.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,956.87 / $13,156.85 / $19,880.16
| Facility | | $7,956.87 | $13,156.85 | $19,880.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,514.36 / $18,514.36 / $18,514.36
| Facility | | $18,514.36 | $18,514.36 | $18,514.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,464.29 / $13,254.34 / $20,467.82
| Facility | | $11,464.29 | $13,254.34 | $20,467.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,693.77 / $34,436.19
| Facility | | $5,840.42 | $12,693.77 | $34,436.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $12,693.77 / $29,971.45
| Facility | | $3,775.00 | $12,693.77 | $29,971.45 |