- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,272.12 / $10,932.50 / $14,273.90
| Facility | | $5,272.12 | $10,932.50 | $14,273.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,854.65 / $26,734.12
| Facility | | $5,840.42 | $9,854.65 | $26,734.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,177.22 / $10,214.16 / $15,433.72
| Facility | | $6,177.22 | $10,214.16 | $15,433.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,505.16 / $14,505.16 / $14,505.16
| Facility | | $14,505.16 | $14,505.16 | $14,505.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,900.16 / $10,289.85 / $15,889.94
| Facility | | $8,900.16 | $10,289.85 | $15,889.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,854.65 / $26,734.12
| Facility | | $5,840.42 | $9,854.65 | $26,734.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $20,892.95
| Facility | | $5,840.42 | $9,750.00 | $20,892.95 |