- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,073.00 / $6,305.00 / $16,968.00
| Facility | | $2,073.00 | $6,305.00 | $16,968.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,640.00 / $10,860.55
| Facility | | $1,763.75 | $6,640.00 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,758.23 / $18,758.23 / $18,758.23
| Facility | | $18,758.23 | $18,758.23 | $18,758.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $481.88 / $1,066.00 / $15,622.00
| Facility | | $481.88 | $1,066.00 | $15,622.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,702.00 / $10,420.00 / $29,844.00
| Facility | | $3,702.00 | $10,420.00 | $29,844.00 |