- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,922.00 / $7,287.50 / $12,177.50
| Facility | | $1,922.00 | $7,287.50 | $12,177.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.90 / $100.00 / $8,964.00
| Facility | | $78.90 | $100.00 | $8,964.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $2,873.00 / $4,817.00
| Facility | | $1,700.00 | $2,873.00 | $4,817.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $948.38 / $2,201.63 / $4,550.00
| Facility | | $948.38 | $2,201.63 | $4,550.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,095.00 / $3,017.00
| Facility | | $540.00 | $1,095.00 | $3,017.00 |