- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $3,684.00 / $12,600.00
| Facility | | $1,150.00 | $3,684.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,140.21 / $6,492.10 / $10,128.21
| Facility | | $4,140.21 | $6,492.10 | $10,128.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,937.60 / $1,937.60 / $1,937.60
| Facility | | $1,937.60 | $1,937.60 | $1,937.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $433.74 / $611.38 / $5,847.50
| Facility | | $433.74 | $611.38 | $5,847.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,900.00 / $5,543.93
| Facility | | $884.00 | $2,900.00 | $5,543.93 |