- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.00 / $4,500.00 / $12,600.00
| Facility | | $1,048.00 | $4,500.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,997.28 / $12,508.22 / $19,618.43
| Facility | | $7,997.28 | $12,508.22 | $19,618.43 |
- 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
- $634.13 / $918.58 / $14,063.00
| Facility | | $634.13 | $918.58 | $14,063.00 |
- 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 |