- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,202.24 / $10,161.70 / $15,491.00
| Facility | | $5,202.24 | $10,161.70 | $15,491.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,411.63 / $11,411.63 / $11,411.63
| Facility | | $11,411.63 | $11,411.63 | $11,411.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,430.29 / $8,652.36 / $13,662.27
| Facility | | $5,430.29 | $8,652.36 | $13,662.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,209.94 / $6,209.94 / $6,209.94
| Facility | | $6,209.94 | $6,209.94 | $6,209.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,951.78 / $9,285.74 / $20,705.78
| Facility | | $3,951.78 | $9,285.74 | $20,705.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.00 / $9,083.45 / $18,400.24
| Facility | | $3,308.00 | $9,083.45 | $18,400.24 |