- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,742.50 / $9,834.24 / $12,840.00
| Facility | | $4,742.50 | $9,834.24 | $12,840.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,980.68 / $24,048.50
| Facility | | $5,840.42 | $8,980.68 | $24,048.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,556.67 / $9,188.08 / $13,883.30
| Facility | | $5,556.67 | $9,188.08 | $13,883.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,048.02 / $13,048.02 / $13,048.02
| Facility | | $13,048.02 | $13,048.02 | $13,048.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,006.08 / $9,256.16 / $14,293.69
| Facility | | $8,006.08 | $9,256.16 | $14,293.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,980.68 / $24,048.50
| Facility | | $5,840.42 | $8,980.68 | $24,048.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,864.68 / $18,794.12
| Facility | | $5,840.42 | $8,864.68 | $18,794.12 |