- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.13 / $2,112.94 / $12,615.00
| Facility | | $1,380.13 | $2,112.94 | $12,615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $13,652.00
| Facility | | $606.10 | $606.10 | $13,652.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.13 / $1,714.82 / $2,687.01
| Facility | | $1,380.13 | $1,714.82 | $2,687.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $14,926.05 / $14,926.05
| Facility | | $5,000.00 | $14,926.05 | $14,926.05 |