- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $9,332.54 / $17,782.79
| Facility | | $7,762.47 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $14,791.08 / $19,952.62
| Facility | | $10,471.29 | $14,791.08 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $12,302.69 / $16,982.44
| Facility | | $10,000.00 | $12,302.69 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,022.64 / $16,218.10
| Facility | | $7,413.10 | $12,022.64 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $11,220.18 / $16,982.44
| Facility | | $7,413.10 | $11,220.18 | $16,982.44 |