- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,075.58 / $12,598.60 / $16,449.20
| Facility | | $6,075.58 | $12,598.60 | $16,449.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,356.47 / $39,000.00
| Facility | | $5,840.42 | $11,356.47 | $39,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,118.61 / $11,770.77 / $17,785.77
| Facility | | $7,118.61 | $11,770.77 | $17,785.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,715.70 / $16,715.70 / $16,715.70
| Facility | | $16,715.70 | $16,715.70 | $16,715.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,256.52 / $11,857.99 / $18,311.52
| Facility | | $10,256.52 | $11,857.99 | $18,311.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $11,356.47 / $39,000.00
| Facility | | $5,840.42 | $11,356.47 | $39,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $9,750.00 / $24,076.98
| Facility | | $5,840.42 | $9,750.00 | $24,076.98 |