- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,670.84 / $11,759.30 / $15,353.40
| Facility | | $5,670.84 | $11,759.30 | $15,353.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,599.94 / $28,755.96
| Facility | | $5,840.42 | $10,599.94 | $28,755.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,644.39 / $10,986.64 / $16,600.93
| Facility | | $6,644.39 | $10,986.64 | $16,600.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,399.31 / $15,399.31 / $15,399.31
| Facility | | $15,399.31 | $15,399.31 | $15,399.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,573.26 / $11,068.05 / $17,091.66
| Facility | | $9,573.26 | $11,068.05 | $17,091.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,599.94 / $28,755.96
| Facility | | $5,840.42 | $10,599.94 | $28,755.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $22,473.04
| Facility | | $5,840.42 | $9,750.00 | $22,473.04 |