- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,293.00 / $4,192.00 / $13,200.00
| Facility | | $1,293.00 | $4,192.00 | $13,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,554.74 / $5,647.22 / $8,922.54
| Facility | | $3,554.74 | $5,647.22 | $8,922.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,351.42 / $1,351.42 / $1,351.42
| Facility | | $1,351.42 | $1,351.42 | $1,351.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.51 / $558.23 / $4,393.26
| Facility | | $416.51 | $558.23 | $4,393.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $1,990.00 / $4,012.00
| Facility | | $575.00 | $1,990.00 | $4,012.00 |