- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $10,000.00 / $13,489.63
| Facility | | $6,309.57 | $10,000.00 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $13,489.63 / $16,595.87
| Facility | | $9,120.11 | $13,489.63 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $12,022.64 / $12,022.64
| Facility | | $12,022.64 | $12,022.64 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $9,772.37 / $13,182.57
| Facility | | $6,456.54 | $9,772.37 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $12,022.64 / $12,022.64
| Facility | | $12,022.64 | $12,022.64 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $8,912.51 / $13,803.84
| Facility | | $5,623.41 | $8,912.51 | $13,803.84 |