- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $4,302.00 / $13,200.00
| Facility | | $1,346.00 | $4,302.00 | $13,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,969.66 / $7,916.26 / $12,639.64
| Facility | | $4,969.66 | $7,916.26 | $12,639.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,184.66 / $2,184.66 / $2,184.66
| Facility | | $2,184.66 | $2,184.66 | $2,184.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $901.82 / $3,365.00 / $9,451.59
| Facility | | $901.82 | $3,365.00 | $9,451.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $5,407.00 / $9,232.95
| Facility | | $1,481.00 | $5,407.00 | $9,232.95 |