- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $3,683.00 / $8,400.00
| Facility | | $1,150.00 | $3,683.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,873.50 / $12,508.22 / $19,762.84
| Facility | | $7,873.50 | $12,508.22 | $19,762.84 |
- 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
- $970.18 / $1,655.02 / $4,193.63
| Facility | | $970.18 | $1,655.02 | $4,193.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.00 / $1,928.00 / $4,012.00
| Facility | | $498.00 | $1,928.00 | $4,012.00 |