- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.00 / $3,779.00 / $12,600.00
| Facility | | $1,048.00 | $3,779.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,085.32 / $6,507.58 / $10,390.44
| Facility | | $4,085.32 | $6,507.58 | $10,390.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.68 / $1,266.68 / $1,266.68
| Facility | | $1,266.68 | $1,266.68 | $1,266.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.63 / $1,030.00 / $5,703.80
| Facility | | $458.63 | $1,030.00 | $5,703.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.00 / $1,928.00 / $3,790.62
| Facility | | $498.00 | $1,928.00 | $3,790.62 |