- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,086.18 / $13,413.60 / $18,000.00
| Facility | | $8,086.18 | $13,413.60 | $18,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,363.45 / $11,363.45 / $11,363.45
| Facility | | $11,363.45 | $11,363.45 | $11,363.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,545.63 / $11,334.49 / $17,822.87
| Facility | | $6,545.63 | $11,334.49 | $17,822.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,639.84 / $10,800.00 / $24,768.72
| Facility | | $6,639.84 | $10,800.00 | $24,768.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,836.48 / $10,599.12 / $15,256.80
| Facility | | $7,836.48 | $10,599.12 | $15,256.80 |