- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.00 / $5,467.00 / $13,151.00
| Facility | | $1,175.00 | $5,467.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,776.50 / $2,943.50 / $5,358.05
| Facility | | $1,776.50 | $2,943.50 | $5,358.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,533.00 / $11,533.00 / $11,533.00
| Facility | | $11,533.00 | $11,533.00 | $11,533.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $603.59 / $1,144.94 / $6,863.75
| Facility | | $603.59 | $1,144.94 | $6,863.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.44 / $3,096.00 / $6,026.00
| Facility | | $980.44 | $3,096.00 | $6,026.00 |