- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $2,128.00 / $6,762.00
| Facility | | $425.00 | $2,128.00 | $6,762.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,894.10 / $6,389.75 / $13,583.50
| Facility | | $2,894.10 | $6,389.75 | $13,583.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $255.77 / $255.77 / $255.77
| Facility | | $255.77 | $255.77 | $255.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,619.61 / $3,619.61 / $3,619.61
| Facility | | $3,619.61 | $3,619.61 | $3,619.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,648.08 / $12,000.00 / $12,000.00
| Facility | | $2,648.08 | $12,000.00 | $12,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.70 / $421.83 / $789.85
| Facility | | $293.70 | $421.83 | $789.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.70 / $425.89 / $802.08
| Facility | | $293.70 | $425.89 | $802.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $564.00 / $2,064.00 / $4,509.00
| Facility | | $564.00 | $2,064.00 | $4,509.00 |