- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.00 / $4,714.28 / $7,838.38
| Facility | | $1,047.00 | $4,714.28 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,034.41 / $5,013.45 / $8,176.28
| Facility | | $2,034.41 | $5,013.45 | $8,176.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.90 / $191.90 / $1,023.75
| Facility | | $191.90 | $191.90 | $1,023.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.22 / $185.28 / $290.27
| Facility | | $157.22 | $185.28 | $290.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.00 / $3,085.00 / $5,060.00
| Facility | | $755.00 | $3,085.00 | $5,060.00 |