- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $4,747.00 / $11,762.00
| Facility | | $1,700.00 | $4,747.00 | $11,762.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,419.30 / $2,333.31 / $5,172.63
| Facility | | $1,419.30 | $2,333.31 | $5,172.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,103.00 / $7,103.00 / $7,103.00
| Facility | | $7,103.00 | $7,103.00 | $7,103.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.13 / $602.80 / $9,189.86
| Facility | | $275.13 | $602.80 | $9,189.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.00 / $3,096.00 / $5,565.00
| Facility | | $1,436.00 | $3,096.00 | $5,565.00 |