- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,245.00 / $2,360.85 / $8,413.00
| Facility | | $1,245.00 | $2,360.85 | $8,413.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $606.10
| Facility | | $606.10 | $606.10 | $606.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,397.00 / $1,647.56 / $2,826.58
| Facility | | $1,397.00 | $1,647.56 | $2,826.58 |
- 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 / $14,670.11 / $17,132.00
| Facility | | $2,000.00 | $14,670.11 | $17,132.00 |