- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,379.70 / $11,155.60 / $14,565.20
| Facility | | $5,379.70 | $11,155.60 | $14,565.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,055.74 / $27,279.63
| Facility | | $5,840.42 | $10,055.74 | $27,279.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.26 / $10,422.58 / $15,748.65
| Facility | | $6,303.26 | $10,422.58 | $15,748.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,801.14 / $14,801.14 / $14,801.14
| Facility | | $14,801.14 | $14,801.14 | $14,801.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,081.77 / $10,499.81 / $16,214.18
| Facility | | $9,081.77 | $10,499.81 | $16,214.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,055.74 / $27,279.63
| Facility | | $5,840.42 | $10,055.74 | $27,279.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $21,319.28
| Facility | | $5,840.42 | $9,750.00 | $21,319.28 |