- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $6,112.00 / $13,023.00
| Facility | | $1,965.00 | $6,112.00 | $13,023.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,598.50 / $10,860.55
| Facility | | $1,763.75 | $6,598.50 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,736.09 / $18,736.09 / $18,736.09
| Facility | | $18,736.09 | $18,736.09 | $18,736.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.66 / $855.13 / $9,437.00
| Facility | | $591.66 | $855.13 | $9,437.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,255.00 / $7,205.00 / $11,396.00
| Facility | | $5,255.00 | $7,205.00 | $11,396.00 |