- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,108.09 / $4,673.00 / $9,870.00
| Facility | | $1,108.09 | $4,673.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,870.00 / $6,825.40 / $12,239.94
| Facility | | $1,870.00 | $6,825.40 | $12,239.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,061.77 / $1,842.86
| Facility | | $375.00 | $1,061.77 | $1,842.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.47 / $1,126.92 / $1,892.43
| Facility | | $950.47 | $1,126.92 | $1,892.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,224.00 / $12,189.00 / $18,722.00
| Facility | | $1,224.00 | $12,189.00 | $18,722.00 |