- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,524.64 / $12,482.10 / $16,750.00
| Facility | | $7,524.64 | $12,482.10 | $16,750.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,613.14 / $15,613.14 / $15,613.14
| Facility | | $15,613.14 | $15,613.14 | $15,613.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,318.85 / $10,876.71 / $17,304.24
| Facility | | $6,318.85 | $10,876.71 | $17,304.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.74 / $10,050.00 / $23,048.67
| Facility | | $6,178.74 | $10,050.00 | $23,048.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,335.83 / $9,939.79 / $14,024.44
| Facility | | $7,335.83 | $9,939.79 | $14,024.44 |