- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,360.14 / $11,115.00 / $14,512.20
| Facility | | $5,360.14 | $11,115.00 | $14,512.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,019.18 / $27,180.45
| Facility | | $5,840.42 | $10,019.18 | $27,180.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,280.35 / $10,384.69 / $15,691.39
| Facility | | $6,280.35 | $10,384.69 | $15,691.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,747.33 / $14,747.33 / $14,747.33
| Facility | | $14,747.33 | $14,747.33 | $14,747.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,048.75 / $10,461.64 / $16,155.23
| Facility | | $9,048.75 | $10,461.64 | $16,155.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,019.18 / $27,180.45
| Facility | | $5,840.42 | $10,019.18 | $27,180.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $21,241.76
| Facility | | $5,840.42 | $9,750.00 | $21,241.76 |