- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,245.00 / $11,525.00 / $17,378.62
| Facility | | $1,245.00 | $11,525.00 | $17,378.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,045.38 / $5,045.38 / $7,209.21
| Facility | | $5,045.38 | $5,045.38 | $7,209.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.10 / $852.10 / $852.10
| Facility | | $852.10 | $852.10 | $852.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,136.31 / $1,481.45 / $2,353.07
| Facility | | $1,136.31 | $1,481.45 | $2,353.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.00 / $12,216.00 / $19,066.00
| Facility | | $3,183.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $16,639.47 / $19,431.84
| Facility | | $2,000.00 | $16,639.47 | $19,431.84 |