- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,897.79 / $11,220.18
| Facility | | $1,071.52 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $8,317.64 / $10,471.29
| Facility | | $3,715.35 | $8,317.64 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $741.31
| Facility | | $724.44 | $724.44 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,000.00 / $1,445.44
| Facility | | $776.25 | $1,000.00 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,715.35 / $6,456.54
| Facility | | $1,548.82 | $3,715.35 | $6,456.54 |