- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,353.43 / $4,919.00 / $12,600.00
| Facility | | $1,353.43 | $4,919.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,831.00 / $3,829.41 / $6,069.38
| Facility | | $2,831.00 | $3,829.41 | $6,069.38 |
- 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
- $907.19 / $1,413.06 / $4,960.00
| Facility | | $907.19 | $1,413.06 | $4,960.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,967.00 / $4,960.00 / $11,732.00
| Facility | | $1,967.00 | $4,960.00 | $11,732.00 |