- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $931.89 / $1,924.00 / $8,949.48
| Facility | | $931.89 | $1,924.00 | $8,949.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $3,967.00 / $8,800.00
| Facility | | $2,088.00 | $3,967.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,005.78 / $1,447.82 / $1,670.18
| Facility | | $1,005.78 | $1,447.82 | $1,670.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.17 / $1,269.96 / $1,269.96
| Facility | | $1,224.17 | $1,269.96 | $1,269.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $4,639.00 / $12,296.00
| Facility | | $973.00 | $4,639.00 | $12,296.00 |