- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $4,195.00 / $13,200.00
| Facility | | $1,346.00 | $4,195.00 | $13,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,227.34 / $8,304.37 / $13,120.82
| Facility | | $5,227.34 | $8,304.37 | $13,120.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,310.61 / $3,310.61 / $3,310.61
| Facility | | $3,310.61 | $3,310.61 | $3,310.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.52 / $1,011.93 / $6,840.79
| Facility | | $770.52 | $1,011.93 | $6,840.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $4,424.00 / $7,077.94
| Facility | | $1,157.00 | $4,424.00 | $7,077.94 |