- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,159.71 / $3,428.55 / $11,500.00
| Facility | | $2,159.71 | $3,428.55 | $11,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $3,528.00 / $14,996.00
| Facility | | $1,760.00 | $3,528.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,550.35 / $3,187.94 / $3,787.93
| Facility | | $2,550.35 | $3,187.94 | $3,787.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,480.00 / $3,086.00 / $6,111.00
| Facility | | $1,480.00 | $3,086.00 | $6,111.00 |