- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,450.00 / $7,670.00 / $17,780.00
| Facility | | $1,450.00 | $7,670.00 | $17,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,565.00 / $6,809.00 / $25,522.00
| Facility | | $2,565.00 | $6,809.00 | $25,522.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.18 / $1,004.62 / $1,243.43
| Facility | | $837.18 | $1,004.62 | $1,243.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,312.66 / $7,285.00 / $12,871.00
| Facility | | $4,312.66 | $7,285.00 | $12,871.00 |