- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,193.00 / $3,193.00 / $3,193.00
| Facility | | $3,193.00 | $3,193.00 | $3,193.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,026.00 / $26,395.47 / $34,220.55
| Facility | | $5,026.00 | $26,395.47 | $34,220.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,510.00 / $12,615.40 / $31,437.58
| Facility | | $5,510.00 | $12,615.40 | $31,437.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,255.96 / $23,356.58 / $26,115.80
| Facility | | $15,255.96 | $23,356.58 | $26,115.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.00 / $2,560.00 / $52,975.67
| Facility | | $1,850.00 | $2,560.00 | $52,975.67 |