- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,923.61 / $12,283.40 / $16,037.80
| Facility | | $5,923.61 | $12,283.40 | $16,037.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,072.42 / $30,037.74
| Facility | | $5,840.42 | $11,072.42 | $30,037.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,940.55 / $11,476.36 / $17,340.91
| Facility | | $6,940.55 | $11,476.36 | $17,340.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,968.51 / $15,968.51 / $15,968.51
| Facility | | $15,968.51 | $15,968.51 | $15,968.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,999.98 / $11,561.39 / $17,853.50
| Facility | | $9,999.98 | $11,561.39 | $17,853.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,072.42 / $30,037.74
| Facility | | $5,840.42 | $11,072.42 | $30,037.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $23,474.76
| Facility | | $5,840.42 | $9,750.00 | $23,474.76 |