- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $10,000.00 / $11,481.54
| Facility | | $7,244.36 | $10,000.00 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $7,244.36 / $7,943.28
| Facility | | $5,754.40 | $7,244.36 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $9,772.37 / $12,589.25
| Facility | | $5,495.41 | $9,772.37 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $7,244.36 / $18,197.01
| Facility | | $4,786.30 | $7,244.36 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $7,244.36 / $10,715.19
| Facility | | $5,128.61 | $7,244.36 | $10,715.19 |