- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,002.40 / $8,503.40 / $14,307.70
| Facility | | $6,002.40 | $8,503.40 | $14,307.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,056.73 / $9,056.73 / $9,056.73
| Facility | | $9,056.73 | $9,056.73 | $9,056.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,790.00 / $3,447.00 / $8,708.95
| Facility | | $1,790.00 | $3,447.00 | $8,708.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,450.58 / $9,783.91 / $16,407.56
| Facility | | $6,450.58 | $9,783.91 | $16,407.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,873.00 / $5,606.00 / $15,128.05
| Facility | | $1,873.00 | $5,606.00 | $15,128.05 |