- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,502.56 / $9,062.00 / $22,776.00
| Facility | | $2,502.56 | $9,062.00 | $22,776.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.39 / $1,061.39 / $1,061.39
| Facility | | $1,061.39 | $1,061.39 | $1,061.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $560.00 / $615.00
| Facility | | $100.00 | $560.00 | $615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,170.03 / $2,655.09 / $4,289.82
| Facility | | $2,170.03 | $2,655.09 | $4,289.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.00 / $6,074.00 / $8,818.00
| Facility | | $454.00 | $6,074.00 | $8,818.00 |