- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,184.00 / $4,192.00 / $13,200.00
| Facility | | $1,184.00 | $4,192.00 | $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
- $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
- $598.04 / $904.14 / $9,344.49
| Facility | | $598.04 | $904.14 | $9,344.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $6,871.00 / $14,139.00
| Facility | | $1,851.00 | $6,871.00 | $14,139.00 |