- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $3,981.07
| Facility | | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,786.30 / $10,000.00
| Facility | | $1,737.80 | $4,786.30 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $338.84
| Facility | | $199.53 | $199.53 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $3,981.07
| Facility | | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.96 / $35.48 / $602.56
| Facility | | $10.96 | $35.48 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $489.78 / $4,168.69
| Facility | | $39.81 | $489.78 | $4,168.69 |