- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,293.00 / $4,192.00 / $13,200.00
| Facility | | $1,293.00 | $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
- $1,070.25 / $1,070.25 / $1,070.25
| Facility | | $1,070.25 | $1,070.25 | $1,070.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $592.44 / $1,822.00 / $6,167.00
| Facility | | $592.44 | $1,822.00 | $6,167.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,875.93 / $5,543.93
| Facility | | $884.00 | $2,875.93 | $5,543.93 |