- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.00 / $3,821.00 / $12,600.00
| Facility | | $1,048.00 | $3,821.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,554.74 / $5,647.22 / $8,922.54
| Facility | | $3,554.74 | $5,647.22 | $8,922.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.78 / $2,545.78 / $2,545.78
| Facility | | $2,545.78 | $2,545.78 | $2,545.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.00 / $876.75 / $4,393.26
| Facility | | $660.00 | $876.75 | $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 |