- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $10,471.29 / $19,952.62
| Facility | | $5,888.44 | $10,471.29 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $11,481.54 / $19,054.61
| Facility | | $6,456.54 | $11,481.54 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $7,585.78 / $16,218.10
| Facility | | $100.00 | $7,585.78 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $9,549.93 / $18,197.01
| Facility | | $6,606.93 | $9,549.93 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $18,620.87 / $18,620.87
| Facility | | $18,620.87 | $18,620.87 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $10,471.29 / $20,417.38
| Facility | | $6,456.54 | $10,471.29 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $9,332.54 / $18,197.01
| Facility | | $5,011.87 | $9,332.54 | $18,197.01 |