- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,680.62 / $11,779.60 / $15,379.90
| Facility | | $5,680.62 | $11,779.60 | $15,379.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,618.22 / $28,805.55
| Facility | | $5,840.42 | $10,618.22 | $28,805.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,655.84 / $11,005.58 / $16,629.57
| Facility | | $6,655.84 | $11,005.58 | $16,629.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,629.06 / $15,629.06 / $15,629.06
| Facility | | $15,629.06 | $15,629.06 | $15,629.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,589.77 / $11,087.13 / $17,121.14
| Facility | | $9,589.77 | $11,087.13 | $17,121.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,618.22 / $28,805.55
| Facility | | $5,840.42 | $10,618.22 | $28,805.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $22,511.80
| Facility | | $5,840.42 | $9,750.00 | $22,511.80 |