- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,489.53 / $11,383.30 / $14,862.50
| Facility | | $5,489.53 | $11,383.30 | $14,862.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,261.04 / $27,836.60
| Facility | | $5,840.42 | $10,261.04 | $27,836.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.96 / $10,635.38 / $16,070.18
| Facility | | $6,431.96 | $10,635.38 | $16,070.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,103.33 / $15,103.33 / $15,103.33
| Facility | | $15,103.33 | $15,103.33 | $15,103.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,267.19 / $10,714.19 / $16,545.22
| Facility | | $9,267.19 | $10,714.19 | $16,545.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,261.04 / $27,836.60
| Facility | | $5,840.42 | $10,261.04 | $27,836.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $21,754.55
| Facility | | $5,840.42 | $9,750.00 | $21,754.55 |