- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,176.50 / $1,303.88 / $4,846.00
| Facility | | $1,176.50 | $1,303.88 | $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
- $1,086.57 / $1,412.54 / $1,629.86
| Facility | | $1,086.57 | $1,412.54 | $1,629.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,399.70
| Facility | | $761.00 | $761.00 | $1,399.70 |
- 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 |