- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,472.23 / $11,347.40 / $14,815.70
| Facility | | $5,472.23 | $11,347.40 | $14,815.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,228.70 / $27,748.86
| Facility | | $5,840.42 | $10,228.70 | $27,748.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,411.68 / $10,601.86 / $16,019.53
| Facility | | $6,411.68 | $10,601.86 | $16,019.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,055.73 / $15,055.73 / $15,055.73
| Facility | | $15,055.73 | $15,055.73 | $15,055.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,237.98 / $10,680.41 / $16,493.07
| Facility | | $9,237.98 | $10,680.41 | $16,493.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,228.70 / $27,748.86
| Facility | | $5,840.42 | $10,228.70 | $27,748.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $10,228.70 / $24,151.13
| Facility | | $3,775.00 | $10,228.70 | $24,151.13 |