- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $3,821.00 / $12,600.00
| Facility | | $1,150.00 | $3,821.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,064.77 / $6,457.50 / $10,202.77
| Facility | | $4,064.77 | $6,457.50 | $10,202.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.78 / $2,545.78 / $2,545.78
| Facility | | $2,545.78 | $2,545.78 | $2,545.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $424.47 / $600.91 / $6,840.79
| Facility | | $424.47 | $600.91 | $6,840.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $4,054.00 / $7,077.94
| Facility | | $1,157.00 | $4,054.00 | $7,077.94 |