- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,911.57 / $12,258.50 / $16,005.20
| Facility | | $5,911.57 | $12,258.50 | $16,005.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,049.92 / $29,976.70
| Facility | | $5,840.42 | $11,049.92 | $29,976.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,926.45 / $11,453.04 / $17,305.66
| Facility | | $6,926.45 | $11,453.04 | $17,305.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,264.49 / $16,264.49 / $16,264.49
| Facility | | $16,264.49 | $16,264.49 | $16,264.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,979.66 / $11,537.90 / $17,817.23
| Facility | | $9,979.66 | $11,537.90 | $17,817.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,049.92 / $29,976.70
| Facility | | $5,840.42 | $11,049.92 | $29,976.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $23,427.06
| Facility | | $5,840.42 | $9,750.00 | $23,427.06 |