- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,330.05 / $11,052.60 / $14,430.70
| Facility | | $5,330.05 | $11,052.60 | $14,430.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,962.93 / $27,027.86
| Facility | | $5,840.42 | $9,962.93 | $27,027.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,245.09 / $10,326.39 / $15,603.30
| Facility | | $6,245.09 | $10,326.39 | $15,603.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,664.53 / $14,664.53 / $14,664.53
| Facility | | $14,664.53 | $14,664.53 | $14,664.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,997.95 / $10,402.91 / $16,064.53
| Facility | | $8,997.95 | $10,402.91 | $16,064.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,962.93 / $27,027.86
| Facility | | $5,840.42 | $9,962.93 | $27,027.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $21,122.51
| Facility | | $5,840.42 | $9,750.00 | $21,122.51 |