- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,471.29 / $14,125.38
| Facility | | $6,606.93 | $10,471.29 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $18,620.87 / $22,908.68
| Facility | | $12,589.25 | $18,620.87 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $12,589.25
| Facility | | $12,589.25 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $10,000.00 / $13,182.57
| Facility | | $6,760.83 | $10,000.00 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $12,589.25
| Facility | | $12,589.25 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $9,332.54 / $14,454.40
| Facility | | $5,888.44 | $9,332.54 | $14,454.40 |