- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $4,195.00 / $13,200.00
| Facility | | $1,346.00 | $4,195.00 | $13,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,409.25 / $10,182.03 / $16,087.50
| Facility | | $6,409.25 | $10,182.03 | $16,087.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,491.09 / $1,491.09 / $1,491.09
| Facility | | $1,491.09 | $1,491.09 | $1,491.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.85 / $614.86 / $5,558.80
| Facility | | $402.85 | $614.86 | $5,558.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $942.00 / $3,710.26 / $5,847.50
| Facility | | $942.00 | $3,710.26 | $5,847.50 |