- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $4,756.00 / $13,200.00
| Facility | | $1,150.00 | $4,756.00 | $13,200.00 |
- 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
- $638.37 / $1,332.67 / $12,719.00
| Facility | | $638.37 | $1,332.67 | $12,719.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,570.00 / $6,980.00 / $13,541.98
| Facility | | $1,570.00 | $6,980.00 | $13,541.98 |