- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $11,748.98 / $19,952.62
| Facility | | $5,754.40 | $11,748.98 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $10,715.19 / $28,840.32
| Facility | | $6,165.95 | $10,715.19 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $11,220.18 / $16,982.44
| Facility | | $6,606.93 | $11,220.18 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $16,595.87 / $16,595.87
| Facility | | $16,595.87 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $10,715.19 / $28,840.32
| Facility | | $6,165.95 | $10,715.19 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $10,715.19 / $28,840.32
| Facility | | $6,165.95 | $10,715.19 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $8,912.51 / $25,118.86
| Facility | | $6,165.95 | $8,912.51 | $25,118.86 |