- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $13,182.57 / $21,877.62
| Facility | | $6,309.57 | $13,182.57 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,022.64 / $32,359.37
| Facility | | $6,165.95 | $12,022.64 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,589.25 / $18,620.87
| Facility | | $7,413.10 | $12,589.25 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $18,197.01 / $18,197.01
| Facility | | $18,197.01 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $11,748.98 / $32,359.37
| Facility | | $6,165.95 | $11,748.98 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,022.64 / $32,359.37
| Facility | | $6,165.95 | $12,022.64 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $9,772.37 / $28,183.83
| Facility | | $6,165.95 | $9,772.37 | $28,183.83 |