- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $7,585.78 / $7,585.78
| Facility | | $7,585.78 | $7,585.78 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $10,000.00 / $18,197.01
| Facility | | $5,888.44 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,908.68 / $30,199.52 / $31,622.78
| Facility | | $22,908.68 | $30,199.52 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $7,585.78 / $16,595.87
| Facility | | $7,585.78 | $7,585.78 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $12,302.69 / $18,197.01
| Facility | | $7,943.28 | $12,302.69 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $11,220.18 / $12,022.64
| Facility | | $8,709.64 | $11,220.18 | $12,022.64 |