- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,312.05 / $3,742.00 / $18,600.00
| Facility | | $1,312.05 | $3,742.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,444.76 / $15,004.39 / $23,706.76
| Facility | | $9,444.76 | $15,004.39 | $23,706.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $900.00 / $900.00
| Facility | | $900.00 | $900.00 | $900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,127.24 / $1,903.19 / $5,897.00
| Facility | | $1,127.24 | $1,903.19 | $5,897.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $1,928.00 / $7,223.00
| Facility | | $350.00 | $1,928.00 | $7,223.00 |