- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,020.00 / $5,427.00 / $7,061.00
| Facility | | $5,020.00 | $5,427.00 | $7,061.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,300.00 / $12,300.00 / $12,300.00
| Facility | | $12,300.00 | $12,300.00 | $12,300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.47 / $3,460.80 / $5,469.89
| Facility | | $155.47 | $3,460.80 | $5,469.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,378.00 / $5,562.00 / $7,061.00
| Facility | | $5,378.00 | $5,562.00 | $7,061.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $819.61 / $1,807.27 / $12,029.11
| Facility | | $819.61 | $1,807.27 | $12,029.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,300.00 / $12,300.00 / $12,300.00
| Facility | | $12,300.00 | $12,300.00 | $12,300.00 |