- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,245.00 / $4,376.00 / $12,154.00
| Facility | | $1,245.00 | $4,376.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,397.00 / $3,082.87 / $5,128.54
| Facility | | $1,397.00 | $3,082.87 | $5,128.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $8,660.00 / $8,660.00
| Facility | | $505.00 | $8,660.00 | $8,660.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.95 / $931.08 / $10,015.00
| Facility | | $595.95 | $931.08 | $10,015.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,433.87 / $5,625.00 / $10,716.00
| Facility | | $2,433.87 | $5,625.00 | $10,716.00 |