- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,387.97 / $11,172.70 / $14,587.60
| Facility | | $5,387.97 | $11,172.70 | $14,587.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,071.20 / $27,321.60
| Facility | | $5,840.42 | $10,071.20 | $27,321.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,312.96 / $10,438.62 / $15,772.87
| Facility | | $6,312.96 | $10,438.62 | $15,772.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,823.91 / $14,823.91 / $14,823.91
| Facility | | $14,823.91 | $14,823.91 | $14,823.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,095.74 / $10,515.96 / $16,239.12
| Facility | | $9,095.74 | $10,515.96 | $16,239.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,071.20 / $27,321.60
| Facility | | $5,840.42 | $10,071.20 | $27,321.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $21,352.07
| Facility | | $5,840.42 | $9,750.00 | $21,352.07 |