- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,029.72 / $4,376.00 / $12,600.00
| Facility | | $1,029.72 | $4,376.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,339.50 / $1,881.58 / $3,130.84
| Facility | | $1,339.50 | $1,881.58 | $3,130.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $505.00 / $505.00
| Facility | | $505.00 | $505.00 | $505.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.92 / $942.01 / $3,331.00
| Facility | | $612.92 | $942.01 | $3,331.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.00 / $2,081.00 / $3,918.00
| Facility | | $825.00 | $2,081.00 | $3,918.00 |