- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,930.00 / $7,365.00 / $13,151.00
| Facility | | $1,930.00 | $7,365.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,312.00 / $3,237.02 / $6,817.19
| Facility | | $2,312.00 | $3,237.02 | $6,817.19 |
- 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
- $1,124.00 / $1,982.32 / $5,897.00
| Facility | | $1,124.00 | $1,982.32 | $5,897.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.00 / $1,743.00 / $12,736.00
| Facility | | $783.00 | $1,743.00 | $12,736.00 |