- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $2,794.39 / $6,681.00
| Facility | | $1,150.00 | $2,794.39 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,439.00 / $5,060.00 / $9,272.00
| Facility | | $2,439.00 | $5,060.00 | $9,272.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $728.00 / $3,203.00 / $4,038.10
| Facility | | $728.00 | $3,203.00 | $4,038.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,820.68 / $16,547.20 / $26,542.00
| Facility | | $3,820.68 | $16,547.20 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,351.00 / $6,285.00
| Facility | | $1,000.00 | $3,351.00 | $6,285.00 |