- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $841.00 / $2,418.00 / $7,267.50
| Facility | | $841.00 | $2,418.00 | $7,267.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,302.58 / $11,743.76 / $17,253.59
| Facility | | $6,302.58 | $11,743.76 | $17,253.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $751.30 / $6,298.85 / $6,298.85
| Facility | | $751.30 | $6,298.85 | $6,298.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,400.00 / $1,400.00
| Facility | | $1,400.00 | $1,400.00 | $1,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $5,780.00 / $13,506.00
| Facility | | $1,200.00 | $5,780.00 | $13,506.00 |