- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.00 / $4,728.00 / $14,100.00
| Facility | | $1,456.00 | $4,728.00 | $14,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,319.62 / $8,473.71 / $13,529.71
| Facility | | $5,319.62 | $8,473.71 | $13,529.71 |
- 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
- $1,408.97 / $2,554.00 / $8,198.00
| Facility | | $1,408.97 | $2,554.00 | $8,198.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $4,054.00 / $7,077.94
| Facility | | $1,157.00 | $4,054.00 | $7,077.94 |