- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $3,803.00 / $12,600.00
| Facility | | $1,150.00 | $3,803.00 | $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
- $686.89 / $1,032.90 / $6,840.79
| Facility | | $686.89 | $1,032.90 | $6,840.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $4,054.00 / $7,077.94
| Facility | | $1,157.00 | $4,054.00 | $7,077.94 |