- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $4,500.00 / $12,600.00
| Facility | | $1,150.00 | $4,500.00 | $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
- $803.03 / $1,045.09 / $6,840.79
| Facility | | $803.03 | $1,045.09 | $6,840.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,243.00 / $5,068.00 / $8,392.00
| Facility | | $1,243.00 | $5,068.00 | $8,392.00 |