- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $11,220.18 / $18,620.87
| Facility | | $5,370.32 | $11,220.18 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $10,232.93 / $27,542.29
| Facility | | $6,165.95 | $10,232.93 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $10,715.19 / $15,848.93
| Facility | | $6,309.57 | $10,715.19 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $15,488.17 / $15,488.17
| Facility | | $15,488.17 | $15,488.17 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $10,000.00 / $27,542.29
| Facility | | $6,165.95 | $10,000.00 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $10,232.93 / $27,542.29
| Facility | | $6,165.95 | $10,232.93 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $8,511.38 / $23,988.33
| Facility | | $6,165.95 | $8,511.38 | $23,988.33 |