- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,163.00 / $3,684.00 / $12,600.00
| Facility | | $1,163.00 | $3,684.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,500.79 / $8,738.79 / $13,807.20
| Facility | | $5,500.79 | $8,738.79 | $13,807.20 |
- 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
- $613.62 / $853.55 / $6,840.79
| Facility | | $613.62 | $853.55 | $6,840.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,415.00 / $5,147.21 / $8,116.00
| Facility | | $1,415.00 | $5,147.21 | $8,116.00 |