- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,521.00 / $9,112.00
| Facility | | $1,965.00 | $4,521.00 | $9,112.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,610.00 / $21,806.40 / $34,544.40
| Facility | | $5,610.00 | $21,806.40 | $34,544.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.00 / $600.00 / $1,357.00
| Facility | | $600.00 | $600.00 | $1,357.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,304.84 / $3,026.85 / $10,939.00
| Facility | | $1,304.84 | $3,026.85 | $10,939.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,255.00 / $8,241.00 / $16,051.00
| Facility | | $5,255.00 | $8,241.00 | $16,051.00 |