- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,640.93 / $9,623.64 / $12,565.00
| Facility | | $4,640.93 | $9,623.64 | $12,565.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,788.36 / $23,533.50
| Facility | | $5,840.42 | $8,788.36 | $23,533.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,848.83 / $8,544.68 / $12,466.32
| Facility | | $5,848.83 | $8,544.68 | $12,466.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,768.60 / $12,768.60 / $12,768.60
| Facility | | $12,768.60 | $12,768.60 | $12,768.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,834.63 / $9,057.94 / $13,987.59
| Facility | | $7,834.63 | $9,057.94 | $13,987.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,788.36 / $23,533.50
| Facility | | $5,840.42 | $8,788.36 | $23,533.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $8,674.85 / $18,391.64
| Facility | | $5,840.42 | $8,674.85 | $18,391.64 |