- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,178.83 / $10,739.00 / $14,021.30
| Facility | | $5,178.83 | $10,739.00 | $14,021.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $26,261.08
| Facility | | $5,840.42 | $9,750.00 | $26,261.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,067.92 / $10,033.43 / $15,160.63
| Facility | | $6,067.92 | $10,033.43 | $15,160.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,248.50 / $14,248.50 / $14,248.50
| Facility | | $14,248.50 | $14,248.50 | $14,248.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,742.68 / $10,107.78 / $15,608.78
| Facility | | $8,742.68 | $10,107.78 | $15,608.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $26,261.08
| Facility | | $5,840.42 | $9,750.00 | $26,261.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,680.28 / $20,523.27
| Facility | | $5,840.42 | $9,680.28 | $20,523.27 |