- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.00 / $4,928.00 / $16,400.00
| Facility | | $1,392.00 | $4,928.00 | $16,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,444.76 / $15,004.39 / $23,706.76
| Facility | | $9,444.76 | $15,004.39 | $23,706.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $900.00 / $900.00
| Facility | | $900.00 | $900.00 | $900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,416.46 / $3,425.25 / $18,958.34
| Facility | | $2,416.46 | $3,425.25 | $18,958.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,228.00 / $10,642.00 / $20,423.23
| Facility | | $3,228.00 | $10,642.00 | $20,423.23 |