- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,184.00 / $5,170.00 / $13,200.00
| Facility | | $1,184.00 | $5,170.00 | $13,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,019.62 / $12,575.25 / $19,618.43
| Facility | | $8,019.62 | $12,575.25 | $19,618.43 |
- 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
- $581.52 / $810.83 / $11,495.55
| Facility | | $581.52 | $810.83 | $11,495.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $7,074.00 / $14,139.00
| Facility | | $1,851.00 | $7,074.00 | $14,139.00 |