- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.00 / $3,803.00 / $12,600.00
| Facility | | $1,048.00 | $3,803.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,854.01 / $6,027.89 / $9,454.41
| Facility | | $3,854.01 | $6,027.89 | $9,454.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,491.09 / $1,491.09 / $1,491.09
| Facility | | $1,491.09 | $1,491.09 | $1,491.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.07 / $677.16 / $5,543.93
| Facility | | $410.07 | $677.16 | $5,543.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,900.00 / $5,543.93
| Facility | | $884.00 | $2,900.00 | $5,543.93 |