- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $11,481.54 / $15,135.61
| Facility | | $7,079.46 | $11,481.54 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $21,877.62 / $26,915.35
| Facility | | $15,135.61 | $21,877.62 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $13,803.84 / $13,803.84
| Facility | | $13,803.84 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $11,481.54 / $15,488.17
| Facility | | $7,585.78 | $11,481.54 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $13,803.84 / $13,803.84
| Facility | | $13,803.84 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $10,000.00 / $15,848.93
| Facility | | $6,309.57 | $10,000.00 | $15,848.93 |