- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,131.00 / $6,560.00 / $13,151.00
| Facility | | $3,131.00 | $6,560.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,312.00 / $3,196.22 / $5,128.54
| Facility | | $2,312.00 | $3,196.22 | $5,128.54 |
- 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
- $2,335.35 / $3,732.00 / $6,446.30
| Facility | | $2,335.35 | $3,732.00 | $6,446.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,967.00 / $4,916.00 / $11,732.00
| Facility | | $1,967.00 | $4,916.00 | $11,732.00 |