- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,824.00 / $4,161.00 / $10,746.00
| Facility | | $1,824.00 | $4,161.00 | $10,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,439.00 / $5,022.00 / $9,272.00
| Facility | | $2,439.00 | $5,022.00 | $9,272.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $3,671.00 / $4,939.00
| Facility | | $500.00 | $3,671.00 | $4,939.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,644.48 / $16,894.64 / $26,542.00
| Facility | | $13,644.48 | $16,894.64 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $4,937.00 / $10,111.00
| Facility | | $1,485.00 | $4,937.00 | $10,111.00 |