- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $975.00 / $3,682.00 / $12,281.00
| Facility | | $975.00 | $3,682.00 | $12,281.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,056.70 / $1,056.70 / $1,075.05
| Facility | | $1,056.70 | $1,056.70 | $1,075.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,102.00 / $26,542.00 / $26,542.00
| Facility | | $11,102.00 | $26,542.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,059.28 / $1,307.03 / $1,806.46
| Facility | | $1,059.28 | $1,307.03 | $1,806.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,059.55 / $1,307.30 / $1,862.61
| Facility | | $1,059.55 | $1,307.30 | $1,862.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.00 / $4,345.00 / $10,600.00
| Facility | | $1,634.00 | $4,345.00 | $10,600.00 |