- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,521.88 / $11,450.40 / $14,950.10
| Facility | | $5,521.88 | $11,450.40 | $14,950.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,321.51 / $28,000.63
| Facility | | $5,840.42 | $10,321.51 | $28,000.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,469.86 / $10,698.05 / $16,164.88
| Facility | | $6,469.86 | $10,698.05 | $16,164.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,192.33 / $15,192.33 / $15,192.33
| Facility | | $15,192.33 | $15,192.33 | $15,192.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,321.79 / $10,777.32 / $16,642.72
| Facility | | $9,321.79 | $10,777.32 | $16,642.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,321.51 / $28,000.63
| Facility | | $5,840.42 | $10,321.51 | $28,000.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $21,882.74
| Facility | | $5,840.42 | $9,750.00 | $21,882.74 |