- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.00 / $3,803.00 / $12,600.00
| Facility | | $1,048.00 | $3,803.00 | $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
- $5,659.86 / $5,659.86 / $5,659.86
| Facility | | $5,659.86 | $5,659.86 | $5,659.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $639.91 / $875.00 / $5,882.00
| Facility | | $639.91 | $875.00 | $5,882.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.00 / $3,680.00 / $5,962.62
| Facility | | $886.00 | $3,680.00 | $5,962.62 |