- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,131.43 / $10,640.80 / $13,893.00
| Facility | | $5,131.43 | $10,640.80 | $13,893.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,717.20 / $26,020.75
| Facility | | $5,840.42 | $9,717.20 | $26,020.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,012.38 / $9,941.61 / $15,021.89
| Facility | | $6,012.38 | $9,941.61 | $15,021.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,118.11 / $14,118.11 / $14,118.11
| Facility | | $14,118.11 | $14,118.11 | $14,118.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,662.67 / $10,015.27 / $15,465.94
| Facility | | $8,662.67 | $10,015.27 | $15,465.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,717.20 / $26,020.75
| Facility | | $5,840.42 | $9,717.20 | $26,020.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,591.69 / $20,335.45
| Facility | | $5,840.42 | $9,591.69 | $20,335.45 |