- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $4,728.00 / $14,100.00
| Facility | | $1,346.00 | $4,728.00 | $14,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,723.84 / $13,547.08 / $21,288.26
| Facility | | $8,723.84 | $13,547.08 | $21,288.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,321.00 / $2,321.00 / $2,321.00
| Facility | | $2,321.00 | $2,321.00 | $2,321.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $939.25 / $1,850.80 / $13,541.98
| Facility | | $939.25 | $1,850.80 | $13,541.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $7,527.19 / $13,541.98
| Facility | | $1,851.00 | $7,527.19 | $13,541.98 |