- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $8,317.64 / $12,302.69
| Facility | | $6,309.57 | $8,317.64 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $12,302.69 / $12,302.69
| Facility | | $12,302.69 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $7,244.36 / $12,022.64
| Facility | | $4,677.35 | $7,244.36 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $10,000.00 / $14,125.38
| Facility | | $6,309.57 | $10,000.00 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $8,912.51 / $13,803.84
| Facility | | $6,309.57 | $8,912.51 | $13,803.84 |