- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.00 / $4,195.00 / $7,310.00
| Facility | | $1,300.00 | $4,195.00 | $7,310.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,873.50 / $12,508.22 / $19,762.84
| Facility | | $7,873.50 | $12,508.22 | $19,762.84 |
- 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
- $502.04 / $697.66 / $5,962.62
| Facility | | $502.04 | $697.66 | $5,962.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.00 / $3,317.00 / $5,543.93
| Facility | | $886.00 | $3,317.00 | $5,543.93 |