- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $8,101.00 / $14,345.00
| Facility | | $2,400.00 | $8,101.00 | $14,345.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,855.70 / $6,109.09 / $7,187.16
| Facility | | $2,855.70 | $6,109.09 | $7,187.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,517.00 / $12,517.00 / $12,517.00
| Facility | | $12,517.00 | $12,517.00 | $12,517.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $806.72 / $1,379.23 / $26,542.00
| Facility | | $806.72 | $1,379.23 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,967.00 / $4,960.00 / $11,732.00
| Facility | | $1,967.00 | $4,960.00 | $11,732.00 |