- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,301.00 / $2,747.00 / $8,247.00
| Facility | | $1,301.00 | $2,747.00 | $8,247.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,531.00 / $27,840.00 / $46,296.00
| Facility | | $13,531.00 | $27,840.00 | $46,296.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,143.75 / $2,143.75 / $2,143.75
| Facility | | $2,143.75 | $2,143.75 | $2,143.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $4,761.00 / $8,427.00
| Facility | | $1,013.00 | $4,761.00 | $8,427.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,143.75 / $2,143.75 / $2,143.75
| Facility | | $2,143.75 | $2,143.75 | $2,143.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,833.18 / $1,833.18 / $2,045.78
| Facility | | $1,833.18 | $1,833.18 | $2,045.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $6,515.00 / $12,076.00
| Facility | | $3,340.00 | $6,515.00 | $12,076.00 |