- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $9,120.11 / $9,120.11
| Facility | | $9,120.11 | $9,120.11 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $15,848.93 / $24,547.09
| Facility | | $9,772.37 | $15,848.93 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,542.29 / $36,307.81 / $38,018.94
| Facility | | $27,542.29 | $36,307.81 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $9,120.11 / $21,877.62
| Facility | | $9,120.11 | $9,120.11 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $15,135.61 / $21,877.62
| Facility | | $10,000.00 | $15,135.61 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $13,489.63 / $14,791.08
| Facility | | $10,715.19 | $13,489.63 | $14,791.08 |