- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,880.73 / $12,194.50 / $15,921.70
| Facility | | $5,880.73 | $12,194.50 | $15,921.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,992.27 / $29,820.29
| Facility | | $5,840.42 | $10,992.27 | $29,820.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,890.31 / $11,393.28 / $17,215.38
| Facility | | $6,890.31 | $11,393.28 | $17,215.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,179.63 / $16,179.63 / $16,179.63
| Facility | | $16,179.63 | $16,179.63 | $16,179.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,927.59 / $11,477.70 / $17,724.27
| Facility | | $9,927.59 | $11,477.70 | $17,724.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,992.27 / $29,820.29
| Facility | | $5,840.42 | $10,992.27 | $29,820.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,775.00 / $10,992.27 / $25,954.00
| Facility | | $3,775.00 | $10,992.27 | $25,954.00 |