- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $3,779.00 / $12,600.00
| Facility | | $1,150.00 | $3,779.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,602.87 / $8,785.64 / $13,706.31
| Facility | | $5,602.87 | $8,785.64 | $13,706.31 |
- 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
- $673.01 / $1,029.85 / $8,986.49
| Facility | | $673.01 | $1,029.85 | $8,986.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $5,973.00 / $11,050.00
| Facility | | $1,481.00 | $5,973.00 | $11,050.00 |