- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.00 / $4,192.00 / $13,200.00
| Facility | | $1,300.00 | $4,192.00 | $13,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,653.33 / $10,598.22 / $16,921.82
| Facility | | $6,653.33 | $10,598.22 | $16,921.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,655.49 / $1,655.49 / $1,655.49
| Facility | | $1,655.49 | $1,655.49 | $1,655.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $722.93 / $2,495.00 / $7,992.00
| Facility | | $722.93 | $2,495.00 | $7,992.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $3,858.00 / $7,077.94
| Facility | | $1,157.00 | $3,858.00 | $7,077.94 |