- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,657.36 / $16,019.90 / $21,497.50
| Facility | | $9,657.36 | $16,019.90 | $21,497.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,860.00 / $1,860.00 / $1,860.00
| Facility | | $1,860.00 | $1,860.00 | $1,860.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,779.61 / $13,106.45 / $20,398.61
| Facility | | $7,779.61 | $13,106.45 | $20,398.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,930.00 / $12,898.50 / $29,581.42
| Facility | | $7,930.00 | $12,898.50 | $29,581.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,359.15 / $12,711.04 / $17,999.43
| Facility | | $9,359.15 | $12,711.04 | $17,999.43 |