- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,870.00 / $14,245.90 / $18,600.09
| Facility | | $6,870.00 | $14,245.90 | $18,600.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,841.42 / $34,836.75
| Facility | | $5,840.42 | $12,841.42 | $34,836.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,049.42 / $13,309.89 / $20,111.40
| Facility | | $8,049.42 | $13,309.89 | $20,111.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,901.41 / $18,901.41 / $18,901.41
| Facility | | $18,901.41 | $18,901.41 | $18,901.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,597.64 / $13,408.52 / $20,705.90
| Facility | | $11,597.64 | $13,408.52 | $20,705.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $12,841.42 / $34,836.75
| Facility | | $5,840.42 | $12,841.42 | $34,836.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $10,117.34 / $27,225.23
| Facility | | $5,840.42 | $10,117.34 | $27,225.23 |