- 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
- $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
- $7,610.74 / $7,610.74 / $7,610.74
| Facility | | $7,610.74 | $7,610.74 | $7,610.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $757.15 / $1,058.07 / $11,495.55
| Facility | | $757.15 | $1,058.07 | $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 |