- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,676.86 / $11,771.80 / $15,369.70
| Facility | | $5,676.86 | $11,771.80 | $15,369.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,611.19 / $28,786.48
| Facility | | $5,840.42 | $10,611.19 | $28,786.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,651.44 / $10,998.30 / $16,618.56
| Facility | | $6,651.44 | $10,998.30 | $16,618.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,618.71 / $15,618.71 / $15,618.71
| Facility | | $15,618.71 | $15,618.71 | $15,618.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,583.42 / $11,079.79 / $17,109.80
| Facility | | $9,583.42 | $11,079.79 | $17,109.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,611.19 / $28,786.48
| Facility | | $5,840.42 | $10,611.19 | $28,786.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $22,496.89
| Facility | | $5,840.42 | $9,750.00 | $22,496.89 |