- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,317.64 / $10,000.00
| Facility | | $6,918.31 | $8,317.64 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $12,022.64
| Facility | | $7,413.10 | $7,413.10 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $8,511.38 / $13,182.57
| Facility | | $6,606.93 | $8,511.38 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $11,220.18 / $11,220.18
| Facility | | $5,011.87 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $9,549.93 / $14,125.38
| Facility | | $6,918.31 | $9,549.93 | $14,125.38 |