- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,131.00 / $7,655.00 / $14,450.00
| Facility | | $3,131.00 | $7,655.00 | $14,450.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,055.00 / $17,041.68 / $17,938.62
| Facility | | $2,055.00 | $17,041.68 | $17,938.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $985.00 / $985.00 / $985.00
| Facility | | $985.00 | $985.00 | $985.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,186.11 / $1,853.80 / $17,483.00
| Facility | | $1,186.11 | $1,853.80 | $17,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,729.00 / $8,000.00 / $17,483.00
| Facility | | $2,729.00 | $8,000.00 | $17,483.00 |