- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $4,192.00 / $13,200.00
| Facility | | $1,346.00 | $4,192.00 | $13,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,334.45 / $14,829.12 / $23,429.85
| Facility | | $9,334.45 | $14,829.12 | $23,429.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,237.33 / $6,237.33 / $6,237.33
| Facility | | $6,237.33 | $6,237.33 | $6,237.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.40 / $1,899.25 / $7,497.24
| Facility | | $1,100.40 | $1,899.25 | $7,497.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $5,524.00 / $9,232.95
| Facility | | $1,481.00 | $5,524.00 | $9,232.95 |