- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,615.00 / $1,764.20 / $7,439.00
| Facility | | $1,615.00 | $1,764.20 | $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
- $1,764.20 / $2,217.05 / $3,522.06
| Facility | | $1,764.20 | $2,217.05 | $3,522.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $806.00 / $3,994.00 / $6,543.00
| Facility | | $806.00 | $3,994.00 | $6,543.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $22,619.74 / $22,619.74
| Facility | | $5,000.00 | $22,619.74 | $22,619.74 |