- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $13,489.63 / $22,908.68
| Facility | | $6,606.93 | $13,489.63 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,589.25 / $33,113.11
| Facility | | $6,165.95 | $12,589.25 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $12,882.50 / $19,498.45
| Facility | | $7,762.47 | $12,882.50 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,054.61 / $19,054.61 / $19,054.61
| Facility | | $19,054.61 | $19,054.61 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,302.69 / $33,113.11
| Facility | | $6,165.95 | $12,302.69 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,589.25 / $33,113.11
| Facility | | $6,165.95 | $12,589.25 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $10,000.00 / $28,840.32
| Facility | | $6,165.95 | $10,000.00 | $28,840.32 |