- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,914.29 / $4,470.00 / $12,600.00
| Facility | | $1,914.29 | $4,470.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,374.10 / $1,446.42
| Facility | | $627.00 | $1,374.10 | $1,446.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.00 / $624.00 / $624.00
| Facility | | $624.00 | $624.00 | $624.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.56 / $2,064.76 / $4,140.17
| Facility | | $1,230.56 | $2,064.76 | $4,140.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.00 / $3,096.00 / $5,565.00
| Facility | | $1,436.00 | $3,096.00 | $5,565.00 |