- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,843.00 / $10,439.00
| Facility | | $1,000.00 | $3,843.00 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,156.00 / $2,112.67 / $2,943.50
| Facility | | $1,156.00 | $2,112.67 | $2,943.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,690.00 / $9,690.00 / $9,690.00
| Facility | | $9,690.00 | $9,690.00 | $9,690.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.07 / $364.67 / $9,451.00
| Facility | | $195.07 | $364.67 | $9,451.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,779.00 / $3,647.00 / $6,988.00
| Facility | | $1,779.00 | $3,647.00 | $6,988.00 |