- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.16 / $1,509.26 / $4,846.00
| Facility | | $1,375.16 | $1,509.26 | $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
- $1,257.72 / $1,635.04 / $1,886.58
| Facility | | $1,257.72 | $1,635.04 | $1,886.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,647.91
| Facility | | $761.00 | $761.00 | $1,647.91 |
- 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 |