- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,654.29 / $11,725.00 / $15,308.60
| Facility | | $5,654.29 | $11,725.00 | $15,308.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,569.00 / $28,672.04
| Facility | | $5,840.42 | $10,569.00 | $28,672.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,624.99 / $10,954.57 / $16,552.49
| Facility | | $6,624.99 | $10,954.57 | $16,552.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,556.62 / $15,556.62 / $15,556.62
| Facility | | $15,556.62 | $15,556.62 | $15,556.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,545.32 / $11,035.74 / $17,041.78
| Facility | | $9,545.32 | $11,035.74 | $17,041.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,569.00 / $28,672.04
| Facility | | $5,840.42 | $10,569.00 | $28,672.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $22,407.45
| Facility | | $5,840.42 | $9,750.00 | $22,407.45 |