- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,636.98 / $11,689.10 / $15,261.70
| Facility | | $5,636.98 | $11,689.10 | $15,261.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,536.66 / $28,584.30
| Facility | | $5,840.42 | $10,536.66 | $28,584.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,604.72 / $10,921.05 / $16,501.83
| Facility | | $6,604.72 | $10,921.05 | $16,501.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,509.01 / $15,509.01 / $15,509.01
| Facility | | $15,509.01 | $15,509.01 | $15,509.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,516.11 / $11,001.97 / $16,989.63
| Facility | | $9,516.11 | $11,001.97 | $16,989.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,536.66 / $28,584.30
| Facility | | $5,840.42 | $10,536.66 | $28,584.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $22,338.88
| Facility | | $5,840.42 | $9,750.00 | $22,338.88 |