- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,716.00 / $2,716.00 / $3,294.00
| Facility | | $2,716.00 | $2,716.00 | $3,294.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,799.28 / $5,266.29 / $7,095.63
| Facility | | $1,799.28 | $5,266.29 | $7,095.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.86 / $454.00 / $2,626.50
| Facility | | $407.86 | $454.00 | $2,626.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.58 / $500.00 / $1,300.00
| Facility | | $258.58 | $500.00 | $1,300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $500.00 / $1,149.00
| Facility | | $500.00 | $500.00 | $1,149.00 |