- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,296.50 / $2,897.00 / $6,483.00
| Facility | | $1,296.50 | $2,897.00 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.35 / $2,197.38 / $3,616.69
| Facility | | $587.35 | $2,197.38 | $3,616.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,833.49 / $2,833.49 / $2,833.49
| Facility | | $2,833.49 | $2,833.49 | $2,833.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.40 / $682.31 / $3,801.00
| Facility | | $540.40 | $682.31 | $3,801.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.00 / $3,339.00 / $5,838.00
| Facility | | $2,343.00 | $3,339.00 | $5,838.00 |