- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,238.19 / $10,500.00 / $27,740.70
| Facility | | $1,238.19 | $10,500.00 | $27,740.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.42 / $5,500.30 / $8,760.50
| Facility | | $2,430.42 | $5,500.30 | $8,760.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $560.00 / $715.00
| Facility | | $100.00 | $560.00 | $715.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $978.57 / $1,238.19 / $2,104.92
| Facility | | $978.57 | $1,238.19 | $2,104.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.00 / $12,269.00 / $19,591.00
| Facility | | $870.00 | $12,269.00 | $19,591.00 |