- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,615.00 / $1,728.54 / $7,439.00
| Facility | | $1,615.00 | $1,728.54 | $7,439.00 |
- 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
- $1,728.54 / $2,148.09 / $3,466.74
| Facility | | $1,728.54 | $2,148.09 | $3,466.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $21,913.76 / $21,913.76
| Facility | | $5,000.00 | $21,913.76 | $21,913.76 |