- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $896.00 / $1,781.55 / $10,152.00
| Facility | | $896.00 | $1,781.55 | $10,152.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,049.25 / $9,122.94 / $15,243.15
| Facility | | $5,049.25 | $9,122.94 | $15,243.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.65 / $1,877.16 / $2,165.44
| Facility | | $1,367.65 | $1,877.16 | $2,165.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,648.88 / $1,648.88 / $1,648.88
| Facility | | $1,648.88 | $1,648.88 | $1,648.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.00 / $2,513.00 / $27,879.00
| Facility | | $405.00 | $2,513.00 | $27,879.00 |