- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,804.00 / $2,715.00 / $6,681.00
| Facility | | $1,804.00 | $2,715.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,355.00 / $6,246.00 / $13,081.00
| Facility | | $2,355.00 | $6,246.00 | $13,081.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $525.00 / $2,277.00
| Facility | | $500.00 | $525.00 | $2,277.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,371.60 / $22,189.40 / $22,189.40
| Facility | | $9,371.60 | $22,189.40 | $22,189.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,100.00 / $10,226.00 / $20,054.00
| Facility | | $3,100.00 | $10,226.00 | $20,054.00 |