- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.00 / $5,551.00 / $16,900.00
| Facility | | $1,456.00 | $5,551.00 | $16,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,585.95 / $10,462.75 / $16,531.03
| Facility | | $6,585.95 | $10,462.75 | $16,531.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.01 / $2,248.01 / $2,248.01
| Facility | | $2,248.01 | $2,248.01 | $2,248.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $749.96 / $1,019.45 / $6,184.00
| Facility | | $749.96 | $1,019.45 | $6,184.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $942.00 / $3,869.00 / $6,161.83
| Facility | | $942.00 | $3,869.00 | $6,161.83 |