- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.50 / $1,245.00 / $10,561.00
| Facility | | $549.50 | $1,245.00 | $10,561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $2,710.28
| Facility | | $748.70 | $748.70 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.50 / $689.91 / $1,184.00
| Facility | | $549.50 | $689.91 | $1,184.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,733.00 / $6,543.00
| Facility | | $900.00 | $3,733.00 | $6,543.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $7,817.95 / $8,957.00
| Facility | | $2,000.00 | $7,817.95 | $8,957.00 |