- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,628.00 / $3,500.00 / $17,225.00
| Facility | | $1,628.00 | $3,500.00 | $17,225.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,587.48 / $29,200.00 / $56,650.00
| Facility | | $2,587.48 | $29,200.00 | $56,650.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,618.23 / $2,221.10 / $3,331.65
| Facility | | $1,618.23 | $2,221.10 | $3,331.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,302.96 / $18,302.96 / $21,696.36
| Facility | | $18,302.96 | $18,302.96 | $21,696.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,475.00 / $14,307.00 / $19,962.00
| Facility | | $6,475.00 | $14,307.00 | $19,962.00 |