- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,188.72 / $4,248.00 / $7,562.14
| Facility | | $1,188.72 | $4,248.00 | $7,562.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.35 / $2,515.38 / $4,140.09
| Facility | | $672.35 | $2,515.38 | $4,140.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,605.92 / $3,605.92 / $3,605.92
| Facility | | $3,605.92 | $3,605.92 | $3,605.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $493.35 / $668.27 / $4,702.00
| Facility | | $493.35 | $668.27 | $4,702.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,878.00 / $4,545.00 / $7,217.00
| Facility | | $2,878.00 | $4,545.00 | $7,217.00 |