- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,248.00 / $4,833.00 / $16,400.00
| Facility | | $1,248.00 | $4,833.00 | $16,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,723.84 / $13,547.08 / $21,288.26
| Facility | | $8,723.84 | $13,547.08 | $21,288.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,321.00 / $2,321.00 / $2,321.00
| Facility | | $2,321.00 | $2,321.00 | $2,321.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.19 / $1,481.00 / $12,300.92
| Facility | | $933.19 | $1,481.00 | $12,300.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,280.00 / $5,524.00 / $9,232.95
| Facility | | $1,280.00 | $5,524.00 | $9,232.95 |