- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,864.93 / $12,161.80 / $15,878.90
| Facility | | $5,864.93 | $12,161.80 | $15,878.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,962.74 / $29,740.18
| Facility | | $5,840.42 | $10,962.74 | $29,740.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,871.80 / $11,362.67 / $17,169.13
| Facility | | $6,871.80 | $11,362.67 | $17,169.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,136.16 / $16,136.16 / $16,136.16
| Facility | | $16,136.16 | $16,136.16 | $16,136.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,900.92 / $11,446.87 / $17,676.65
| Facility | | $9,900.92 | $11,446.87 | $17,676.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,962.74 / $29,740.18
| Facility | | $5,840.42 | $10,962.74 | $29,740.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $23,242.21
| Facility | | $5,840.42 | $9,750.00 | $23,242.21 |