- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,198.50 / $1,331.56 / $4,846.00
| Facility | | $1,198.50 | $1,331.56 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,683.00 / $11,305.00 / $30,091.00
| Facility | | $1,683.00 | $11,305.00 | $30,091.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,109.08 / $1,441.80 / $1,663.62
| Facility | | $1,109.08 | $1,441.80 | $1,663.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,432.07
| Facility | | $761.00 | $761.00 | $1,432.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.00 / $5,076.00 / $10,396.00
| Facility | | $612.00 | $5,076.00 | $10,396.00 |