- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,779.92 / $11,985.50 / $15,648.70
| Facility | | $5,779.92 | $11,985.50 | $15,648.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,803.83 / $29,309.11
| Facility | | $5,840.42 | $10,803.83 | $29,309.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,772.20 / $11,197.97 / $16,920.27
| Facility | | $6,772.20 | $11,197.97 | $16,920.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,902.27 / $15,902.27 / $15,902.27
| Facility | | $15,902.27 | $15,902.27 | $15,902.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,757.41 / $11,280.95 / $17,420.43
| Facility | | $9,757.41 | $11,280.95 | $17,420.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,803.83 / $29,309.11
| Facility | | $5,840.42 | $10,803.83 | $29,309.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $22,905.33
| Facility | | $5,840.42 | $9,750.00 | $22,905.33 |