- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,854.40 / $12,139.90 / $15,850.40
| Facility | | $5,854.40 | $12,139.90 | $15,850.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,943.05 / $29,686.77
| Facility | | $5,840.42 | $10,943.05 | $29,686.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,859.46 / $11,342.27 / $17,138.30
| Facility | | $6,859.46 | $11,342.27 | $17,138.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,107.18 / $16,107.18 / $16,107.18
| Facility | | $16,107.18 | $16,107.18 | $16,107.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,883.14 / $11,426.31 / $17,644.91
| Facility | | $9,883.14 | $11,426.31 | $17,644.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,943.05 / $29,686.77
| Facility | | $5,840.42 | $10,943.05 | $29,686.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $23,200.48
| Facility | | $5,840.42 | $9,750.00 | $23,200.48 |