- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,508.00 / $7,361.00 / $10,035.00
| Facility | | $3,508.00 | $7,361.00 | $10,035.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,203.19 / $3,082.00 / $5,405.31
| Facility | | $2,203.19 | $3,082.00 | $5,405.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $6,956.81 / $10,765.00
| Facility | | $350.00 | $6,956.81 | $10,765.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,416.00 / $4,416.00 / $4,416.00
| Facility | | $4,416.00 | $4,416.00 | $4,416.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $516.00 / $565.00 / $2,414.00
| Facility | | $516.00 | $565.00 | $2,414.00 |