- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.00 / $2,500.00 / $7,495.00
| Facility | | $696.00 | $2,500.00 | $7,495.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,395.37 / $7,275.80 / $14,212.05
| Facility | | $3,395.37 | $7,275.80 | $14,212.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.26 / $550.26 / $550.26
| Facility | | $550.26 | $550.26 | $550.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,187.68 / $4,187.68 / $4,187.68
| Facility | | $4,187.68 | $4,187.68 | $4,187.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,335.00 / $16,394.00 / $16,394.00
| Facility | | $4,335.00 | $16,394.00 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $638.41 / $897.04 / $1,749.45
| Facility | | $638.41 | $897.04 | $1,749.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $638.41 / $901.34 / $1,782.45
| Facility | | $638.41 | $901.34 | $1,782.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,314.00 / $7,600.00
| Facility | | $1,154.00 | $3,314.00 | $7,600.00 |