- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $12,589.25 / $20,892.96
| Facility | | $6,025.60 | $12,589.25 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $11,481.54 / $38,904.51
| Facility | | $6,165.95 | $11,481.54 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $12,022.64 / $18,197.01
| Facility | | $7,079.46 | $12,022.64 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $17,378.01 / $17,378.01
| Facility | | $17,378.01 | $17,378.01 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $11,481.54 / $30,902.95
| Facility | | $6,165.95 | $11,481.54 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $11,481.54 / $38,904.51
| Facility | | $6,165.95 | $11,481.54 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $9,549.93 / $26,915.35
| Facility | | $6,165.95 | $9,549.93 | $26,915.35 |