- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $4,888.00 / $12,473.00
| Facility | | $2,100.00 | $4,888.00 | $12,473.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,341.54 / $4,934.39 / $8,070.83
| Facility | | $1,341.54 | $4,934.39 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,044.37 / $8,044.37 / $8,044.37
| Facility | | $8,044.37 | $8,044.37 | $8,044.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.44 / $293.00 / $9,978.00
| Facility | | $164.44 | $293.00 | $9,978.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,315.00 / $7,341.00 / $11,396.00
| Facility | | $5,315.00 | $7,341.00 | $11,396.00 |