- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $7,655.00 / $14,345.00
| Facility | | $2,400.00 | $7,655.00 | $14,345.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,556.44 / $3,767.96 / $5,975.63
| Facility | | $2,556.44 | $3,767.96 | $5,975.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $985.00 / $985.00 / $985.00
| Facility | | $985.00 | $985.00 | $985.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $753.75 / $1,176.30 / $11,209.00
| Facility | | $753.75 | $1,176.30 | $11,209.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,967.00 / $4,960.00 / $11,702.05
| Facility | | $1,967.00 | $4,960.00 | $11,702.05 |