- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.00 / $3,803.00 / $12,600.00
| Facility | | $1,048.00 | $3,803.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,064.77 / $6,457.50 / $10,202.77
| Facility | | $4,064.77 | $6,457.50 | $10,202.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,351.42 / $1,351.42 / $1,351.42
| Facility | | $1,351.42 | $1,351.42 | $1,351.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $731.30 / $967.82 / $6,228.72
| Facility | | $731.30 | $967.82 | $6,228.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,243.00 / $5,068.00 / $8,392.00
| Facility | | $1,243.00 | $5,068.00 | $8,392.00 |