- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,395.50 / $11,188.30 / $14,607.90
| Facility | | $5,395.50 | $11,188.30 | $14,607.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,085.27 / $27,359.75
| Facility | | $5,840.42 | $10,085.27 | $27,359.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,321.77 / $10,453.19 / $15,794.90
| Facility | | $6,321.77 | $10,453.19 | $15,794.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,844.61 / $14,844.61 / $14,844.61
| Facility | | $14,844.61 | $14,844.61 | $14,844.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,108.44 / $10,530.65 / $16,261.79
| Facility | | $9,108.44 | $10,530.65 | $16,261.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,085.27 / $27,359.75
| Facility | | $5,840.42 | $10,085.27 | $27,359.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $21,381.88
| Facility | | $5,840.42 | $9,750.00 | $21,381.88 |