- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,205.18 / $4,376.00 / $12,600.00
| Facility | | $1,205.18 | $4,376.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,074.00 / $1,450.76 / $2,299.67
| Facility | | $1,074.00 | $1,450.76 | $2,299.67 |
- 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
- $717.37 / $1,145.00 / $3,331.00
| Facility | | $717.37 | $1,145.00 | $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 |