- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,791.12 / $7,655.00 / $14,450.00
| Facility | | $1,791.12 | $7,655.00 | $14,450.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.66 / $6,215.56 / $7,433.33
| Facility | | $108.66 | $6,215.56 | $7,433.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,782.00 / $3,365.00 / $3,365.00
| Facility | | $1,782.00 | $3,365.00 | $3,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,092.17 / $1,558.22 / $8,280.00
| Facility | | $1,092.17 | $1,558.22 | $8,280.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,967.00 / $4,643.00 / $11,732.00
| Facility | | $1,967.00 | $4,643.00 | $11,732.00 |