- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,190.12 / $10,762.40 / $14,051.90
| Facility | | $5,190.12 | $10,762.40 | $14,051.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $26,318.31
| Facility | | $5,840.42 | $9,750.00 | $26,318.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,081.14 / $10,055.29 / $15,193.67
| Facility | | $6,081.14 | $10,055.29 | $15,193.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,279.55 / $14,279.55 / $14,279.55
| Facility | | $14,279.55 | $14,279.55 | $14,279.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,761.73 / $10,129.79 / $15,642.79
| Facility | | $8,761.73 | $10,129.79 | $15,642.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $26,318.31
| Facility | | $5,840.42 | $9,750.00 | $26,318.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,701.37 / $20,567.99
| Facility | | $5,840.42 | $9,701.37 | $20,567.99 |