- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,645.00 / $6,906.00 / $15,147.00
| Facility | | $1,645.00 | $6,906.00 | $15,147.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,250.00 / $10,541.29 / $14,808.11
| Facility | | $7,250.00 | $10,541.29 | $14,808.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,554.00 / $9,292.18 / $13,660.36
| Facility | | $4,554.00 | $9,292.18 | $13,660.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,202.01 / $14,470.01 / $22,740.64
| Facility | | $8,202.01 | $14,470.01 | $22,740.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $11,083.80 / $21,089.38
| Facility | | $3,800.00 | $11,083.80 | $21,089.38 |