- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,553.00 / $5,975.00 / $13,151.00
| Facility | | $2,553.00 | $5,975.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,461.10 / $2,151.96 / $4,532.06
| Facility | | $1,461.10 | $2,151.96 | $4,532.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.00 / $8,660.00 / $8,660.00
| Facility | | $624.00 | $8,660.00 | $8,660.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.56 / $1,235.89 / $11,642.00
| Facility | | $791.56 | $1,235.89 | $11,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,820.00 / $5,693.64 / $10,716.00
| Facility | | $2,820.00 | $5,693.64 | $10,716.00 |