- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,070.00 / $4,919.00 / $12,600.00
| Facility | | $2,070.00 | $4,919.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.55 / $1,074.97 / $2,251.80
| Facility | | $730.55 | $1,074.97 | $2,251.80 |
- 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
- $1,089.08 / $1,883.37 / $3,656.54
| Facility | | $1,089.08 | $1,883.37 | $3,656.54 |
- 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 |