- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.25 / $1,250.53 / $4,846.00
| Facility | | $1,128.25 | $1,250.53 | $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
- $1,042.10 / $1,354.74 / $1,563.17
| Facility | | $1,042.10 | $1,354.74 | $1,563.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,338.13
| Facility | | $761.00 | $761.00 | $1,338.13 |
- 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 |