- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,199.14 / $10,781.20 / $14,076.30
| Facility | | $5,199.14 | $10,781.20 | $14,076.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $26,364.08
| Facility | | $5,840.42 | $9,750.00 | $26,364.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,091.71 / $10,072.78 / $15,220.10
| Facility | | $6,091.71 | $10,072.78 | $15,220.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,304.39 / $14,304.39 / $14,304.39
| Facility | | $14,304.39 | $14,304.39 | $14,304.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,776.96 / $10,147.42 / $15,670.00
| Facility | | $8,776.96 | $10,147.42 | $15,670.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $26,364.08
| Facility | | $5,840.42 | $9,750.00 | $26,364.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,718.25 / $20,603.75
| Facility | | $5,840.42 | $9,718.25 | $20,603.75 |