- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,752.80 / $8,334.85 / $13,712.80
| Facility | | $5,752.80 | $8,334.85 | $13,712.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,890.85 / $10,006.02 / $12,935.76
| Facility | | $9,890.85 | $10,006.02 | $12,935.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,790.00 / $3,447.00 / $8,140.48
| Facility | | $1,790.00 | $3,447.00 | $8,140.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,182.34 / $9,377.06 / $15,725.28
| Facility | | $6,182.34 | $9,377.06 | $15,725.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $7,406.73 / $14,977.41
| Facility | | $2,600.00 | $7,406.73 | $14,977.41 |