- 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
- $5,319.62 / $8,473.71 / $13,529.71
| Facility | | $5,319.62 | $8,473.71 | $13,529.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.25 / $1,070.25 / $1,070.25
| Facility | | $1,070.25 | $1,070.25 | $1,070.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $774.07 / $1,807.00 / $5,882.00
| Facility | | $774.07 | $1,807.00 | $5,882.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.00 / $3,680.00 / $5,847.50
| Facility | | $886.00 | $3,680.00 | $5,847.50 |