- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,263.84 / $10,915.30 / $14,251.50
| Facility | | $5,263.84 | $10,915.30 | $14,251.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,839.18 / $26,692.16
| Facility | | $5,840.42 | $9,839.18 | $26,692.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,167.52 / $10,198.12 / $15,409.49
| Facility | | $6,167.52 | $10,198.12 | $15,409.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,482.39 / $14,482.39 / $14,482.39
| Facility | | $14,482.39 | $14,482.39 | $14,482.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,886.19 / $10,273.70 / $15,865.00
| Facility | | $8,886.19 | $10,273.70 | $15,865.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,839.18 / $26,692.16
| Facility | | $5,840.42 | $9,839.18 | $26,692.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $20,860.16
| Facility | | $5,840.42 | $9,750.00 | $20,860.16 |