- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.00 / $2,640.00 / $5,506.00
| Facility | | $1,170.00 | $2,640.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,598.50 / $10,860.55
| Facility | | $1,763.75 | $6,598.50 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,100.10 / $4,100.10 / $4,100.10
| Facility | | $4,100.10 | $4,100.10 | $4,100.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.05 / $643.76 / $6,063.00
| Facility | | $475.05 | $643.76 | $6,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $4,545.00 / $7,217.00
| Facility | | $2,912.00 | $4,545.00 | $7,217.00 |