- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,296.00 / $1,296.00 / $1,296.00
| Facility | | $1,296.00 | $1,296.00 | $1,296.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,145.47 / $10,140.36 / $19,511.25
| Facility | | $6,145.47 | $10,140.36 | $19,511.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,451.60 / $4,894.79 / $11,775.09
| Facility | | $3,451.60 | $4,894.79 | $11,775.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,805.90 / $4,475.02 / $9,271.73
| Facility | | $2,805.90 | $4,475.02 | $9,271.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,790.53 / $2,455.04 / $3,500.00
| Facility | | $1,790.53 | $2,455.04 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |