- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,439.88 / $11,280.40 / $14,728.10
| Facility | | $5,439.88 | $11,280.40 | $14,728.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,301.28 / $48,537.00
| Facility | | $5,840.42 | $10,301.28 | $48,537.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,128.63 / $10,463.98 / $15,924.83
| Facility | | $6,128.63 | $10,463.98 | $15,924.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,966.72 / $14,966.72 / $14,966.72
| Facility | | $14,966.72 | $14,966.72 | $14,966.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,183.37 / $10,617.28 / $16,395.57
| Facility | | $9,183.37 | $10,617.28 | $16,395.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,301.28 / $48,537.00
| Facility | | $5,840.42 | $10,301.28 | $48,537.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $21,557.78
| Facility | | $5,840.42 | $9,750.00 | $21,557.78 |