- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,553.48 / $11,515.90 / $15,035.70
| Facility | | $5,553.48 | $11,515.90 | $15,035.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,380.57 / $28,160.85
| Facility | | $5,840.42 | $10,380.57 | $28,160.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,506.88 / $10,759.27 / $16,257.38
| Facility | | $6,506.88 | $10,759.27 | $16,257.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,279.26 / $15,279.26 / $15,279.26
| Facility | | $15,279.26 | $15,279.26 | $15,279.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,375.14 / $10,838.99 / $16,737.95
| Facility | | $9,375.14 | $10,838.99 | $16,737.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,380.57 / $28,160.85
| Facility | | $5,840.42 | $10,380.57 | $28,160.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $22,007.96
| Facility | | $5,840.42 | $9,750.00 | $22,007.96 |