- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,248.00 / $5,946.00 / $17,600.00
| Facility | | $1,248.00 | $5,946.00 | $17,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,405.80 / $21,144.87 / $33,649.15
| Facility | | $13,405.80 | $21,144.87 | $33,649.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,516.00 / $5,516.00 / $15,917.00
| Facility | | $5,516.00 | $5,516.00 | $15,917.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.79 / $1,160.00 / $7,223.00
| Facility | | $530.79 | $1,160.00 | $7,223.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $1,760.00 / $6,155.68
| Facility | | $350.00 | $1,760.00 | $6,155.68 |