- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,050.00 / $6,560.00 / $12,154.00
| Facility | | $2,050.00 | $6,560.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,149.20 / $1,318.20 / $3,082.56
| Facility | | $1,149.20 | $1,318.20 | $3,082.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,432.00 / $11,432.00 / $11,432.00
| Facility | | $11,432.00 | $11,432.00 | $11,432.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.63 / $1,840.86 / $7,067.76
| Facility | | $1,089.63 | $1,840.86 | $7,067.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,967.00 / $4,960.00 / $11,732.00
| Facility | | $1,967.00 | $4,960.00 | $11,732.00 |