- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,679.86 / $11,778.00 / $15,377.80
| Facility | | $5,679.86 | $11,778.00 | $15,377.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,616.81 / $28,801.74
| Facility | | $5,840.42 | $10,616.81 | $28,801.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,654.96 / $11,004.13 / $16,627.37
| Facility | | $6,654.96 | $11,004.13 | $16,627.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,626.99 / $15,626.99 / $15,626.99
| Facility | | $15,626.99 | $15,626.99 | $15,626.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,588.50 / $11,085.67 / $17,118.87
| Facility | | $9,588.50 | $11,085.67 | $17,118.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,616.81 / $28,801.74
| Facility | | $5,840.42 | $10,616.81 | $28,801.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $10,616.81 / $25,067.51
| Facility | | $3,775.00 | $10,616.81 | $25,067.51 |