- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,688.89 / $11,796.70 / $15,402.30
| Facility | | $5,688.89 | $11,796.70 | $15,402.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,633.68 / $28,847.52
| Facility | | $5,840.42 | $10,633.68 | $28,847.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,665.54 / $11,021.62 / $16,653.79
| Facility | | $6,665.54 | $11,021.62 | $16,653.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,651.83 / $15,651.83 / $15,651.83
| Facility | | $15,651.83 | $15,651.83 | $15,651.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,603.74 / $11,103.28 / $17,146.08
| Facility | | $9,603.74 | $11,103.28 | $17,146.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,633.68 / $28,847.52
| Facility | | $5,840.42 | $10,633.68 | $28,847.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $22,544.59
| Facility | | $5,840.42 | $9,750.00 | $22,544.59 |