- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,434.68 / $3,550.00
| Facility | | $1,400.00 | $1,434.68 | $3,550.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,526.84 / $1,674.91 / $1,824.84
| Facility | | $1,526.84 | $1,674.91 | $1,824.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,657.19 / $1,657.19 / $1,657.19
| Facility | | $1,657.19 | $1,657.19 | $1,657.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72,034.67 / $72,034.67 / $72,034.67
| Facility | | $72,034.67 | $72,034.67 | $72,034.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,585.53 / $16,585.53 / $16,585.53
| Facility | | $16,585.53 | $16,585.53 | $16,585.53 |