- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,431.61 / $11,263.20 / $14,705.70
| Facility | | $5,431.61 | $11,263.20 | $14,705.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,152.76 / $27,542.86
| Facility | | $5,840.42 | $10,152.76 | $27,542.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,364.08 / $10,523.15 / $15,900.61
| Facility | | $6,364.08 | $10,523.15 | $15,900.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,943.96 / $14,943.96 / $14,943.96
| Facility | | $14,943.96 | $14,943.96 | $14,943.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,169.40 / $10,601.13 / $16,370.63
| Facility | | $9,169.40 | $10,601.13 | $16,370.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,152.76 / $27,542.86
| Facility | | $5,840.42 | $10,152.76 | $27,542.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $21,524.99
| Facility | | $5,840.42 | $9,750.00 | $21,524.99 |