- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.70 / $1,427.27 / $4,846.00
| Facility | | $1,288.70 | $1,427.27 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,600.00 / $11,226.46 / $15,429.17
| Facility | | $4,600.00 | $11,226.46 | $15,429.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,189.39 / $1,546.21 / $1,784.09
| Facility | | $1,189.39 | $1,546.21 | $1,784.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,540.80
| Facility | | $761.00 | $761.00 | $1,540.80 |
- 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 |