- 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
- $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
- $871.41 / $2,554.00 / $7,992.00
| Facility | | $871.41 | $2,554.00 | $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 |