- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,137.96 / $4,073.80
| Facility | | $575.44 | $2,137.96 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,089.30 / $2,951.21
| Facility | | $954.99 | $2,089.30 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $776.25 / $1,479.11
| Facility | | $371.54 | $776.25 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $19,498.45
| Facility | | $3,715.35 | $3,715.35 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,187.76 / $3,981.07
| Facility | | $1,000.00 | $2,187.76 | $3,981.07 |