- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,418.82 / $11,236.70 / $14,671.10
| Facility | | $5,418.82 | $11,236.70 | $14,671.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,128.86 / $27,478.00
| Facility | | $5,840.42 | $10,128.86 | $27,478.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,349.10 / $10,498.37 / $15,863.17
| Facility | | $6,349.10 | $10,498.37 | $15,863.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,908.77 / $14,908.77 / $14,908.77
| Facility | | $14,908.77 | $14,908.77 | $14,908.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,147.81 / $10,576.16 / $16,332.08
| Facility | | $9,147.81 | $10,576.16 | $16,332.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,128.86 / $27,478.00
| Facility | | $5,840.42 | $10,128.86 | $27,478.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $21,474.30
| Facility | | $5,840.42 | $9,750.00 | $21,474.30 |