- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.00 / $3,821.00 / $12,600.00
| Facility | | $1,048.00 | $3,821.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,873.50 / $12,508.22 / $19,762.84
| Facility | | $7,873.50 | $12,508.22 | $19,762.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,637.10 / $7,637.10 / $7,637.10
| Facility | | $7,637.10 | $7,637.10 | $7,637.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.36 / $988.16 / $14,063.00
| Facility | | $707.36 | $988.16 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $7,074.00 / $14,139.00
| Facility | | $1,851.00 | $7,074.00 | $14,139.00 |