- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,414.30 / $11,227.30 / $14,658.80
| Facility | | $5,414.30 | $11,227.30 | $14,658.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,120.42 / $27,455.12
| Facility | | $5,840.42 | $10,120.42 | $27,455.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,343.81 / $10,489.63 / $15,849.95
| Facility | | $6,343.81 | $10,489.63 | $15,849.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,896.35 / $14,896.35 / $14,896.35
| Facility | | $14,896.35 | $14,896.35 | $14,896.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,140.19 / $10,567.36 / $16,318.48
| Facility | | $9,140.19 | $10,567.36 | $16,318.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,120.42 / $27,455.12
| Facility | | $5,840.42 | $10,120.42 | $27,455.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $21,456.42
| Facility | | $5,840.42 | $9,750.00 | $21,456.42 |