- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.91 / $1,197.76 / $4,846.00
| Facility | | $1,083.91 | $1,197.76 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,600.00 / $8,980.45 / $14,278.45
| Facility | | $4,600.00 | $8,980.45 | $14,278.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $998.13 / $1,297.57 / $1,497.20
| Facility | | $998.13 | $1,297.57 | $1,497.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,261.02
| Facility | | $761.00 | $761.00 | $1,261.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,300.00 / $11,200.00 / $17,416.00
| Facility | | $3,300.00 | $11,200.00 | $17,416.00 |