- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.00 / $4,714.00 / $14,100.00
| Facility | | $1,300.00 | $4,714.00 | $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
- $1,070.25 / $1,070.25 / $1,070.25
| Facility | | $1,070.25 | $1,070.25 | $1,070.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.72 / $1,016.58 / $5,834.42
| Facility | | $655.72 | $1,016.58 | $5,834.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.00 / $3,505.00 / $5,847.50
| Facility | | $886.00 | $3,505.00 | $5,847.50 |