- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,615.00 / $1,755.87 / $7,439.00
| Facility | | $1,615.00 | $1,755.87 | $7,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $13,652.00
| Facility | | $606.10 | $606.10 | $13,652.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,755.87 / $2,160.23 / $3,477.28
| Facility | | $1,755.87 | $2,160.23 | $3,477.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $806.00 / $3,994.00 / $6,543.00
| Facility | | $806.00 | $3,994.00 | $6,543.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $22,349.58 / $22,349.58
| Facility | | $5,000.00 | $22,349.58 | $22,349.58 |