- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $1,414.33 / $4,846.00
| Facility | | $1,277.00 | $1,414.33 | $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
- $1,178.60 / $1,532.19 / $1,767.92
| Facility | | $1,178.60 | $1,532.19 | $1,767.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.00 / $761.00 / $1,523.32
| Facility | | $761.00 | $761.00 | $1,523.32 |
- 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 |