- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,788.20 / $12,002.60 / $15,671.10
| Facility | | $5,788.20 | $12,002.60 | $15,671.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,819.30 / $29,351.07
| Facility | | $5,840.42 | $10,819.30 | $29,351.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,781.89 / $11,214.01 / $16,944.50
| Facility | | $6,781.89 | $11,214.01 | $16,944.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,175.77 / $15,175.77 / $15,175.77
| Facility | | $15,175.77 | $15,175.77 | $15,175.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,771.37 / $11,297.10 / $17,445.38
| Facility | | $9,771.37 | $11,297.10 | $17,445.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,819.30 / $29,351.07
| Facility | | $5,840.42 | $10,819.30 | $29,351.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $22,938.12
| Facility | | $5,840.42 | $9,750.00 | $22,938.12 |