- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,321.00 / $5,457.00 / $17,002.00
| Facility | | $1,321.00 | $5,457.00 | $17,002.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $2,806.52 / $7,702.00
| Facility | | $1,550.00 | $2,806.52 | $7,702.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,087.00 / $6,087.00 / $6,087.00
| Facility | | $6,087.00 | $6,087.00 | $6,087.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.00 / $375.00 / $961.00
| Facility | | $330.00 | $375.00 | $961.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $435.00 / $650.00 / $4,547.00
| Facility | | $435.00 | $650.00 | $4,547.00 |