- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $5,011.87
| Facility | | $1,737.80 | $1,737.80 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $10,000.00 / $21,379.62
| Facility | | $4,466.84 | $10,000.00 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $6,309.57 / $15,135.61
| Facility | | $4,466.84 | $6,309.57 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,165.95 / $12,022.64
| Facility | | $4,897.79 | $6,165.95 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,311.31 / $6,918.31
| Facility | | $1,819.70 | $3,311.31 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,248.07 / $8,912.51
| Facility | | $1,584.89 | $5,248.07 | $8,912.51 |