- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,943.28 / $16,595.87
| Facility | | $6,309.57 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,623.41 / $10,000.00
| Facility | | $2,511.89 | $5,623.41 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $707.95
| Facility | | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,348.96 / $2,511.89
| Facility | | $1,047.13 | $1,348.96 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $10,964.78 / $16,982.44
| Facility | | $1,995.26 | $10,964.78 | $16,982.44 |