- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,454.71 / $6,606.93
| Facility | | $645.65 | $2,454.71 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $10,000.00 / $16,595.87
| Facility | | $6,456.54 | $10,000.00 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,187.76 / $12,589.25
| Facility | | $645.65 | $2,187.76 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $7,244.36 / $14,125.38
| Facility | | $1,862.09 | $7,244.36 | $14,125.38 |