- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $5,405.00 / $16,900.00
| Facility | | $1,346.00 | $5,405.00 | $16,900.00 |
- 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
- $3,133.24 / $3,133.24 / $3,133.24
| Facility | | $3,133.24 | $3,133.24 | $3,133.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.82 / $2,744.00 / $13,668.58
| Facility | | $477.82 | $2,744.00 | $13,668.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $7,227.00 / $14,114.00
| Facility | | $1,851.00 | $7,227.00 | $14,114.00 |