- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $4,864.00 / $9,840.44
| Facility | | $900.00 | $4,864.00 | $9,840.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,125.00 / $8,298.24 / $10,688.10
| Facility | | $5,125.00 | $8,298.24 | $10,688.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,601.00 / $5,601.00 / $5,601.00
| Facility | | $5,601.00 | $5,601.00 | $5,601.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,490.00 / $9,099.10 / $14,321.71
| Facility | | $7,490.00 | $9,099.10 | $14,321.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,334.00 / $6,122.00 / $11,936.10
| Facility | | $2,334.00 | $6,122.00 | $11,936.10 |