- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $4,751.47 / $11,009.60
| Facility | | $900.00 | $4,751.47 | $11,009.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $2,100.00 / $3,922.00
| Facility | | $2,100.00 | $2,100.00 | $3,922.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,960.00 / $11,115.77 / $13,217.17
| Facility | | $2,960.00 | $11,115.77 | $13,217.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,379.91 / $10,180.20 / $16,023.32
| Facility | | $8,379.91 | $10,180.20 | $16,023.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,865.00 / $4,215.00 / $12,836.70
| Facility | | $1,865.00 | $4,215.00 | $12,836.70 |