- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $10,000.00 / $13,182.57
| Facility | | $6,165.95 | $10,000.00 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $18,620.87 / $22,908.68
| Facility | | $12,589.25 | $18,620.87 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $11,748.98 / $11,748.98
| Facility | | $11,748.98 | $11,748.98 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $9,549.93 / $12,589.25
| Facility | | $6,309.57 | $9,549.93 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $11,748.98 / $11,748.98
| Facility | | $11,748.98 | $11,748.98 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $8,709.64 / $13,803.84
| Facility | | $5,495.41 | $8,709.64 | $13,803.84 |