- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Facility | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $10,000.00 / $18,197.01
| Facility | | $2,187.76 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,547.09 / $24,547.09 / $24,547.09
| Facility | | $24,547.09 | $24,547.09 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $10,471.29 / $18,620.87
| Facility | | $2,290.87 | $10,471.29 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $18,197.01 / $40,738.03
| Facility | | $812.83 | $18,197.01 | $40,738.03 |