- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.17 / $1,328.94 / $4,846.00
| Facility | | $1,175.17 | $1,328.94 | $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
- $1,078.16 / $1,401.61 / $1,617.24
| Facility | | $1,078.16 | $1,401.61 | $1,617.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,402.80
| Facility | | $761.00 | $761.00 | $1,402.80 |
- 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 |