- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,764.81 / $4,470.00 / $12,600.00
| Facility | | $1,764.81 | $4,470.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,594.10 / $2,251.80 / $3,726.84
| Facility | | $1,594.10 | $2,251.80 | $3,726.84 |
- 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
- $1,137.69 / $1,902.43 / $3,830.42
| Facility | | $1,137.69 | $1,902.43 | $3,830.42 |
- 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 |