- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,194.00 / $1,954.94 / $13,304.00
| Facility | | $1,194.00 | $1,954.94 | $13,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,212.00 / $9,592.68 / $21,957.82
| Facility | | $7,212.00 | $9,592.68 | $21,957.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,284.31 / $1,762.10 / $2,032.70
| Facility | | $1,284.31 | $1,762.10 | $2,032.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,545.94 / $1,545.94 / $1,646.08
| Facility | | $1,545.94 | $1,545.94 | $1,646.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.00 / $4,298.00 / $30,001.00
| Facility | | $599.00 | $4,298.00 | $30,001.00 |