- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.00 / $3,779.00 / $12,600.00
| Facility | | $1,048.00 | $3,779.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,489.71 / $2,379.31 / $3,760.03
| Facility | | $1,489.71 | $2,379.31 | $3,760.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,155.43 / $3,155.43 / $3,155.43
| Facility | | $3,155.43 | $3,155.43 | $3,155.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.13 / $731.82 / $6,889.15
| Facility | | $504.13 | $731.82 | $6,889.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $4,424.00 / $7,077.94
| Facility | | $1,157.00 | $4,424.00 | $7,077.94 |