- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $4,728.00 / $14,100.00
| Facility | | $1,346.00 | $4,728.00 | $14,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,743.32 / $5,962.82 / $9,520.62
| Facility | | $3,743.32 | $5,962.82 | $9,520.62 |
- 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
- $704.60 / $1,214.86 / $5,703.80
| Facility | | $704.60 | $1,214.86 | $5,703.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.00 / $1,928.00 / $4,083.73
| Facility | | $498.00 | $1,928.00 | $4,083.73 |