- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,005.50 / $3,683.00 / $8,400.00
| Facility | | $1,005.50 | $3,683.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,022.15 / $9,567.08 / $15,115.87
| Facility | | $6,022.15 | $9,567.08 | $15,115.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,937.60 / $1,937.60 / $1,937.60
| Facility | | $1,937.60 | $1,937.60 | $1,937.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.00 / $1,270.32 / $4,393.26
| Facility | | $773.00 | $1,270.32 | $4,393.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $1,990.00 / $4,012.00
| Facility | | $575.00 | $1,990.00 | $4,012.00 |