- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,450.00 / $3,296.00 / $12,636.00
| Facility | | $1,450.00 | $3,296.00 | $12,636.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $948.38 / $2,201.63 / $4,550.00
| Facility | | $948.38 | $2,201.63 | $4,550.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $925.00 / $13,940.00
| Facility | | $100.00 | $925.00 | $13,940.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,900.00 / $1,900.00 / $1,900.00
| Facility | | $1,900.00 | $1,900.00 | $1,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.00 / $1,026.00 / $1,591.00
| Facility | | $582.00 | $1,026.00 | $1,591.00 |