- 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
- $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
- $2,545.78 / $2,545.78 / $2,545.78
| Facility | | $2,545.78 | $2,545.78 | $2,545.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.58 / $693.99 / $5,882.00
| Facility | | $509.58 | $693.99 | $5,882.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $3,119.35 / $5,543.93
| Facility | | $884.00 | $3,119.35 | $5,543.93 |