- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,284.13 / $4,301.66 / $17,225.00
| Facility | | $1,284.13 | $4,301.66 | $17,225.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,427.00 / $11,294.00 / $22,813.00
| Facility | | $4,427.00 | $11,294.00 | $22,813.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,389.45 / $1,894.71 / $2,842.07
| Facility | | $1,389.45 | $1,894.71 | $2,842.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,909.74 / $3,909.74 / $3,909.74
| Facility | | $3,909.74 | $3,909.74 | $3,909.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,699.00 / $10,000.00 / $15,750.00
| Facility | | $4,699.00 | $10,000.00 | $15,750.00 |