- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $4,192.00 / $13,200.00
| Facility | | $1,346.00 | $4,192.00 | $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
- $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
- $1,030.36 / $1,400.22 / $6,889.15
| Facility | | $1,030.36 | $1,400.22 | $6,889.15 |
- 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 |