- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.96 / $4,846.00 / $5,672.84
| Facility | | $358.96 | $4,846.00 | $5,672.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.00 / $3,950.00 / $13,810.27
| Facility | | $1,682.00 | $3,950.00 | $13,810.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $342.08 / $435.98 / $503.06
| Facility | | $342.08 | $435.98 | $503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.40 / $2,218.40 / $2,218.40
| Facility | | $2,218.40 | $2,218.40 | $2,218.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,699.00 / $10,000.00 / $15,750.00
| Facility | | $4,699.00 | $10,000.00 | $15,750.00 |