- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $6,918.31 / $10,000.00
| Facility | | $4,265.80 | $6,918.31 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $10,964.78
| Facility | | $10,964.78 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $8,128.31 / $10,964.78
| Facility | | $5,370.32 | $8,128.31 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,079.46 / $11,220.18
| Facility | | $4,365.16 | $7,079.46 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,370.32 / $10,964.78
| Facility | | $2,187.76 | $5,370.32 | $10,964.78 |