- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,548.13 / $7,585.78
| Facility | | $1,380.38 | $3,548.13 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,456.54 / $9,772.37
| Facility | | $2,691.53 | $6,456.54 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,412.54 / $4,897.79
| Facility | | $1,000.00 | $1,412.54 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $16,595.87 / $33,884.42
| Facility | | $16,595.87 | $16,595.87 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,623.41 / $10,000.00
| Facility | | $2,187.76 | $5,623.41 | $10,000.00 |