- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,080.04 / $3,803.00 / $12,600.00
| Facility | | $1,080.04 | $3,803.00 | $12,600.00 |
- 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
- $934.76 / $1,438.24 / $4,393.26
| Facility | | $934.76 | $1,438.24 | $4,393.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $1,928.00 / $4,012.00
| Facility | | $575.00 | $1,928.00 | $4,012.00 |