- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,570.88 / $9,120.11
| Facility | | $1,380.38 | $4,570.88 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,905.46 / $1,905.46
| Facility | | $1,819.70 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Facility | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,000.00 / $3,890.45
| Facility | | $660.69 | $1,000.00 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,398.83 / $3,630.78
| Facility | | $1,023.29 | $2,398.83 | $3,630.78 |