- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,776.16 / $11,977.70 / $15,638.50
| Facility | | $5,776.16 | $11,977.70 | $15,638.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,796.80 / $29,290.03
| Facility | | $5,840.42 | $10,796.80 | $29,290.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,767.79 / $11,190.69 / $16,909.25
| Facility | | $6,767.79 | $11,190.69 | $16,909.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,891.92 / $15,891.92 / $15,891.92
| Facility | | $15,891.92 | $15,891.92 | $15,891.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,751.06 / $11,273.61 / $17,409.09
| Facility | | $9,751.06 | $11,273.61 | $17,409.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,796.80 / $29,290.03
| Facility | | $5,840.42 | $10,796.80 | $29,290.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $22,890.42
| Facility | | $5,840.42 | $9,750.00 | $22,890.42 |